NPIMap

Individual provider Active NPI

Reginique L Green, M.D.

  • Family Medicine Physician
  • Memphis, TN
National Provider Identifier
1952401044
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
48371 Issued in TN
Practice address
5366 Mendenhall Mall
Memphis, TN 38115-4505
Phone
(901) 701-2500
NPI assigned
Sep 25, 2006
Last updated
Mar 17, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 35-74642 OH
Family Medicine Physician 207Q00000X 48371 TN Primary

Addresses

Primary practice location

5366 Mendenhall Mall
Memphis, TN 38115-4505

Mailing address

2595 Central Ave
Memphis, TN 38104-5905
Phone (901) 260-8500

Other practice location 1

5220 Park Ave
Suite 100
Memphis, TN 38119
Phone (901) 685-8245

Other practice location 2

5220 Park Ave
Suite 100
Memphis, TN 38119
Phone (901) 685-8245

Other identifiers 1

IdentifierTypeStateIssuer
2104967MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120427000560 TN Practitioner - Family Practice 4284655705 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Creighton University School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3362 S 3Rd St
Memphis, TN 38109-2944
Phone (901) 271-6300

5366 Mendenhall Mall
Memphis, TN 38115-4505
Phone (901) 271-6100

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35-74642OHMDFamily Medicine Physician
48371TNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Christ Community Health Services Inc CurrentSince Feb 27, 2015 Accepting new patients
Christ Community Health Services Inc CurrentSince Feb 27, 2015 Accepting new patients
Greene Memorial Hospital Services, Inc. Past Accepting new patients
Green and Guirnalda Family Health Center Family Medicine Past Accepting new patients
Christ Community Health Services Inc Past Accepting new patients

Locations

2595 Central Ave
Memphis, TN 38104
Phone (901) 260-8500

5366 Mendenhall Mall
Memphis, TN 38115
Phone (901) 271-6100

969 Frayser Blvd
Memphis, TN 38127
Phone (901) 260-8400

Interoperability endpoints

  • Direct secure messaging: reginique.green@christchs.eclinicaldirectplus.com

Ownership & related parties

All facility ownership & control disclosures 8

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Christ Community Health Services Inc.Memphis, TN, CCN 441809 Federally qualified health center W-2 Managing Employee Jan 5, 2015
Christ Community Health Services Inc.Memphis, TN, CCN 441874 Federally qualified health center W-2 Managing Employee Jan 5, 2015
Christ Community Health Services Inc.Memphis, TN, CCN 441905 Federally qualified health center W-2 Managing Employee Jan 5, 2015
Christ Community Health Services Inc.Memphis, TN, CCN 441931 Federally qualified health center W-2 Managing Employee Jan 5, 2015
Christ Community Health Services Inc.Memphis, TN, CCN 441970 Federally qualified health center W-2 Managing Employee Jan 5, 2015
Christ Community Health Services Inc.Jackson, TN, CCN 441000 Federally qualified health center W-2 Managing Employee Jan 5, 2015
Christ Community Health Services Inc.Memphis, TN, CCN 441006 Federally qualified health center W-2 Managing Employee Jan 5, 2015
Christ Community Health Services Inc.Jackson, TN, CCN 441021 Federally qualified health center W-2 Managing Employee Jan 5, 2015

Owned or controlled facilities with NPI records 8

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1952401044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2595 CENTRAL AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381045905",
            "telephone_number": "901-260-8500",
            "fax_number": "901-260-8598"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5366 MENDENHALL MALL",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381154505",
            "telephone_number": "901-701-2500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5220 Park Ave",
            "address_2": "Suite 100",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "38119",
            "country_code": "US",
            "telephone_number": "901-685-8245",
            "fax_number": "901-685-8248",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5220 Park Ave",
            "address_2": "Suite 100",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "38119",
            "country_code": "US",
            "telephone_number": "901-685-8245",
            "fax_number": "901-685-8248",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GREEN",
        "first_name": "REGINIQUE",
        "middle_name": "L",
        "name_prefix": "Mrs.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-25",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35-74642",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "48371",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2104967",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

Verify at the official NPI Registry.