Individual provider Active NPI

Bridget Dawn Green, PHYSICIAN ASSISTANT

  • Medical Physician Assistant
  • Lincoln, NE
National Provider Identifier
1992905467
Registry record updated Jan 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
1334 Issued in NE
Practice address
4210 Pioneer Woods Dr
Suite a
Lincoln, NE 68506-7561
Phone
(402) 488-4321
Fax
(402) 488-4355
NPI assigned
Jul 23, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 24, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 1334 NE Primary

Addresses

Primary practice location

4210 Pioneer Woods Dr
Suite a
Lincoln, NE 68506-7561

Mailing address

4210 Pioneer Woods Dr
Suite a
Lincoln, NE 68506-7561
Phone (402) 488-4321

Other identifiers 1

IdentifierTypeStateIssuer
1334OtherNENEBRASKA STATE LISENCE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE
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

Enrollment IDStateProvider typePAC IDDetails
I20071106000325 NE Practitioner - Physician Assistant 5092807255 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Urgent Care Clinic of Lincoln PCGroup PAC ID 7214962455, 9 clinicians

Practice addresses (Care Compare)

4210 Pioneer Woods Dr
Suite a
Lincoln, NE 68506-7561
Phone (402) 488-4321

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1334NEMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Urgent Care Clinic of Lincoln, PC CurrentSince Feb 12, 2010 Accepting new patients

Locations

4210 Pioneer Woods Dr
Ste A
Lincoln, NE 68506
Phone (402) 488-4321

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1185148800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1390521600000",
    "number": "1992905467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4210 PIONEER WOODS DR",
            "address_2": "SUITE A",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685067561",
            "telephone_number": "402-488-4321",
            "fax_number": "402-488-4355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4210 PIONEER WOODS DR",
            "address_2": "SUITE A",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685067561",
            "telephone_number": "402-488-4321",
            "fax_number": "402-488-4355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "BRIDGET",
        "middle_name": "DAWN",
        "credential": "PHYSICIAN ASSISTANT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-07-23",
        "last_updated": "2014-01-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NE",
            "license": "1334",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEBRASKA STATE LISENCE",
            "identifier": "1334",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lincoln, NE

Sources for this page

Verify at the official NPI Registry.