NPIMap

Individual provider Active NPI

Jacinta Green, M.D.

  • Internal Medicine Physician
  • Breese, IL
National Provider Identifier
1982830238
Registry record updated Jun 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
036.139092 Issued in IL
Practice address
9401 Holy Cross LN
Breese, IL 62230-3510
Phone
(618) 526-7271
NPI assigned
Jun 1, 2009
Last updated
Jun 1, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 036.139092 IL Primary
Internal Medicine Physician 207R00000X 125:056090 IL
Cardiovascular Disease Physician 207RC0000X 036.139092 IL

Addresses

Primary practice location

9401 Holy Cross LN
Breese, IL 62230-3510

Mailing address

825 Woodlea Rd
Kankakee, IL 60901-8199
Phone (815) 937-0552

Other identifiers 1

IdentifierTypeStateIssuer
036139092MedicaidIL

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jgreen459962@ewd.direct.hshs.org Other

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20151105002305 IL Practitioner - Internal MedicinePractitioner - Cardiovascular Disease (Cardiology) 4688984438 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Theoria MedicalGroup PAC ID 5395098339, 317 clinicians
Complexcare Medical Group Midwest H PLLCGroup PAC ID 0143737148, 128 clinicians
St Josephs Hospital Breese of the Hospital Sisters of the Third OrdeGroup PAC ID 9638064892, shared by 4 NPIs, 33 clinicians

Practice addresses (Care Compare)

201 S 10TH St
Mascoutah, IL 62258-1736
Phone (248) 660-1220

335 Illinois St
Crystal Lake, IL 60014-3618
Phone (815) 459-7791

9401 Holy Cross LN
Breese, IL 62230-3510
Phone (618) 526-7271

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125:056090ILMDInternal Medicine Physician
036.139092ILMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Complexcare Medical Group Midwest H PLLC Internal Medicine CurrentSince Aug 31, 2025 Accepting new patients
Theoria Medical Internal Medicine CurrentSince May 26, 2025 Accepting new patients
Signify Health Medical Associates, PLLC CurrentSince Dec 27, 2024 Accepting new patients

Locations

335 Illinois St
Crystal Lake, IL 60014
Phone (815) 459-7791

471 W Terra Cotta Ave
Crystal Lake, IL 60014
Phone (815) 455-0550

201 S 10th St
Mascoutah, IL 62258
Phone (618) 566-8000

41800 W 11 Mile Rd
Ste 109
Novi, MI 48375
Phone (833) 578-2763

4055 Valley View Ln
Ste 700
Farmers Branch, TX 75244
Phone (469) 466-7007

Interoperability endpoints

  • Direct secure messaging: jgreen459962@ewd.direct.hshs.org

Organizations & group practices 6

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1243814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780272000000",
    "number": "1982830238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 WOODLEA RD",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609018199",
            "telephone_number": "815-937-0552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9401 HOLY CROSS LN",
            "city": "BREESE",
            "state": "IL",
            "postal_code": "622303510",
            "telephone_number": "618-526-7271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "JACINTA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-01",
        "last_updated": "2026-06-01",
        "certification_date": "2026-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036.139092",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "125:056090",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IL",
            "license": "036.139092",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036139092",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jgreen459962@ewd.direct.hshs.org",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CDA/CCD/TXT",
            "address_1": "9401 Holy Cross Ln",
            "city": "Breese",
            "state": "IL",
            "country_code": "US",
            "postal_code": "622303510",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Breese, IL

Sources for this page

Verify at the official NPI Registry.