MACK GREEN (NPI# 1043531676) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043531676 |
| Entity Type | Individual |
| Full Name | MACK GREEN |
| Credential | MD |
| Practice Address |
16008 Kamana Rd Suite 100 Apple Valley CA 92307-1376 |
| Mailing Address |
12277 Apple Valley Rd Pmb 288 Apple Valley CA 92308-1701 |
| Practice Telephone | 7609565200 |
| Practice Fax Number | 7606690793 |
| Mailing Telephone | 7609565200 |
| Mailing Fax Number | 7606690793 |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2015-09-28 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QS0010X |
Family Medicine Specialization: Sports Medicine |
A1259029 | CA | Allopathic & Osteopathic Physicians |
| Street Address |
16008 KAMANA RD SUITE 100 |
| City | APPLE VALLEY |
| State | CA |
| Zip Code | 92307-1376 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356404305 | Michael D Jasso | Physician Assistant | 16008 Kamana Rd, Ste 100, Apple Valley, CA 92307-1376 | 2006-12-19 |
| 1942865605 | Active Life, Inc. | Prosthetic/Orthotic Supplier | 16008 Kamana Rd, Apple Valley, CA 92307-1376 | 2019-05-07 |
| 1457670226 | Southern California Bone and Joint Clinic Inc | Orthopaedic Surgery | 16008 Kamana Rd, Suite 100, Apple Valley, CA 92307-1376 | 2010-05-19 |
| 1922201318 | Tzu-shang Thomas Liu | Orthopaedic Surgery | 16008 Kamana Rd, Suite 100, Apple Valley, CA 92307-1308 | 2007-06-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679106025 | Rajender S. Thakran, M.d., Inc | Specialist | 16030 Kamana Rd, Apple Valley, CA 92307 | 2020-02-13 |
| 1477119980 | Harpreet Singh | Nurse Practitioner | 18300 Ca-18, Apple Valley, Ca 92307, Apple Valley, CA 92307 | 2019-05-10 |
| 1184120784 | Frantz Jean-louis | Nurse Practitioner | 16134 Muni Rd, Apple Valley, CA 92307 | 2018-04-03 |
| 1053862078 | Ashley M Morello | Registered Nurse | Universal Pain Management, 16179 Siskiyou, Apple Valley, CA 92307 | 2016-10-14 |
| 1891191680 | Ann Simonds | Marriage & Family Therapist | 20601 Us Highway 18 Ste 123, Apple Valley, CA 92307 | 2014-11-06 |
| 1396147419 | Aaa Family Medical Group | Family Medicine | 15995 Tuscola Rd Ste 202, Apple Valley, CA 92307 | 2014-09-19 |
| 1659780534 | Relena Tran | Pharmacist | 20251 Highway 18, Apple Valley, CA 92307 | 2014-08-05 |
| 1639508526 | Meagan Katherine Blades | Physician Assistant | 18300 Outer Hwy 18, Apple Valley, CA 92307 | 2013-11-01 |
| 1720341555 | Jonathan Robert Cox | Dermatology | 18523 Corwin Rd Ste G, Apple Valley, CA 92307 | 2012-06-18 |
| 1821364365 | Leary Sport and Spine Chiropractic Inc. | Chiropractor | 18564 Us Highway 18 Suite, 303, Apple Valley, CA 92307 | 2012-03-29 |
| Find all providers in zip 92307 | ||||
| Taxonomy Code | 207QS0010X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Sports Medicine |
| A family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the health care of the individual engaged in physical exercise (sports) whether as an individual or in team participation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Family Medicine, 2007. http://www.theabfm.org/. American Osteopathic Board of Family Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Medicine. |
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| 1902289226 | Daesoon Leem | Family Medicine | 15095 Amargosa Rd, Bldg.1, #102, Victorville, CA 92394 | 2015-07-06 |
| 1114313616 | Michelle Sriwongtong | Family Medicine | 834 Castro St, 3, San Francisco, CA 94114-2858 | 2015-04-10 |
| 1225433006 | Harut Madatovian | Family Medicine | 2595 E Washington Blvd Ste 106, Pasadena, CA 91107-1409 | 2014-10-23 |
| 1760801880 | Kyle William Meyer | Family Medicine | 24910 Las Brisas Rd Ste 105, Murrieta, CA 92562 | 2014-04-16 |
| 1720403553 | Dianne Longo | Family Medicine | 1319 Evergreen Ave, Apt N2, Fullerton, CA 92835-2063 | 2014-03-03 |
| 1255760633 | Steven William Marles | Family Medicine | 4265 Tapestry Way, Turlock, CA 95382-7448 | 2013-11-05 |
| 1497098909 | Joshua David Sampson | Family Medicine | 2299 Post St Ste 107, San Francisco, CA 94115-3460 | 2013-04-03 |
| 1699015529 | Andrew Saleh | Family Medicine | 1370 Rosecrans St Ste A, San Diego, CA 92106-2676 | 2013-03-01 |
| Find all providers with the same taxonomy | ||||
| City | APPLE VALLEY |
| Zip Code | 92307 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.