Charles R Green, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601003793 Issued in MI

Practice address

1937 M 119
Petoskey, MI 49770-8913

Phone

(231) 348-9200

NPI assigned

Nov 14, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Boyne Country Urgent Care PCGroup PAC ID 3173565850, 4 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

0 of 100Reported as individual

Quality

0

Improvement activities

0

Cost

0

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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

• Boyne Country Urgent Care P.C.

  • Dermatopathology Physician
  • Gaylord, MI
  • NPI 1972556702
  Medicare reassignment Care Compare group
• Advanced Dermatology of Michigan PC

  • Dermatology Physician
  • Wyandotte, MI
  • NPI 1851708929
  NPD (past)
• Dermatology Associates of Northern Michigan, P.C.

  • Specialist
  • Petoskey, MI
  • NPI 1811069222
  NPD (past)

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1231113600000",
    "number": "1962574285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1937 M 119",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497708913",
            "telephone_number": "231-348-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1937 M 119",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497708913",
            "telephone_number": "231-348-9200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "CHARLES",
        "middle_name": "R",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-14",
        "last_updated": "2009-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601003793",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Great Lakes Ear Nose & Throat Specialists PC
• Great Lakes Neurology, PC
• Great Lakes Oral and Maxillofacial Surgery P.C.
• Great Lakes TTC,LLC
• John K. Grebe, PSY.D.
• Aaron Charles Greene, P.A.
• Amanda Danielle Greene
• Anthony James Greenough
• Dominic Robert Greenough
• William K Gretzinger, DO

• Physician Assistant in Petoskey, MI
• Providers in Petoskey, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.