Active NPI
Jennifer Green, PA
- Physician Assistant
- Centralia, WA
National Provider Identifier
1982269395
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 914 S Scheuber Rd
Centralia, WA 98531-9027 - Phone
- (508) 243-9771
- NPI assigned
- May 1, 2019
- Last updated
- May 1, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Primary |
Addresses
Primary practice location
914 S Scheuber Rd
Centralia, WA 98531-9027
Mailing address
152 Walton Cir
Paris, TN 38242-9400
Phone (508) 243-9771
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in VA, TN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4147 | TN | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fast Pace Medical Clinic PLLC | Current | Accepting new patients | |
| Fast Pace Medical Clinic PLLC | Current | Accepting new patients |
Interoperability endpoints
- jennifer.green.1@21619.direct.athenahealth.com
Organizations & group practices 3
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.
-
- Family Medicine Physician
- Spring Hill, TN
- NPI 1134452865
-
- Rural Health Clinic/Center
- Chapel Hill, TN
- NPI 1316602774
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1556668800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1556668800000",
"number": "1982269395",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "152 WALTON CIR",
"city": "PARIS",
"state": "TN",
"postal_code": "382429400",
"telephone_number": "508-243-9771"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "914 S SCHEUBER RD",
"city": "CENTRALIA",
"state": "WA",
"postal_code": "985319027",
"telephone_number": "508-243-9771"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "JENNIFER",
"name_prefix": "Miss",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-05-01",
"last_updated": "2019-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Centralia, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2019; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.