CHARLES GARY GREEN (NPI# 1073698189) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073698189 |
| Entity Type | Individual |
| Full Name | CHARLES GARY GREEN |
| Credential | MD |
| Practice Address |
60 Hall Street Susanville CA 96130 |
| Practice Telephone | 5302576010 |
| Practice Fax Number | 5302576038 |
| Mailing Telephone | 5302576010 |
| Mailing Fax Number | 5302576038 |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085B0100X |
Radiology Specialization: Body Imaging |
G46958 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MEDICAL PIN | 5424723 | 01 | |
| BLUE CROSS | 00G469580 | 01 | |
| CA | 00G469582 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891285730 | Charles Green | Non-emergency Medical Transport (VAN) | 89 Hunt Ct Apt A, Columbia, SC 29206-5958 | 2018-05-16 |
| 1811266927 | Charles Perry Green | Community Health Worker | 3361 No Kid Rd, Kamiah, ID 83536-5002 | 2011-12-19 |
| 1336262559 | Charles Bruce Green | Family Medicine | Hq Usaf Sg, 1780 Air Force Pentagon, Washington, DC 20330-0001 | 2007-04-10 |
| 1588735146 | Charles Goodwin Green | Pharmacist | 221 S Midland Ave, Monroe, GA 30655-1629 | 2006-11-13 |
| 1154801421 | Charles Green | Behavior Technician | 1819 E Springfield Ave Ste H, Spokane, WA 99202-2954 | 2018-08-16 |
| 1285110460 | Charles Jacob Green IIi | Social Worker | 2272 Collingwood Blvd, Toledo, OH 43620-1147 | 2018-07-11 |
| 1093226706 | Charles Levon Green | Counselor | 803 W 4th Street, Suite D, Pueblo, CO 81003 | 2017-10-20 |
| 1124471784 | Charles Green | Counselor | 684 Ellis St, San Francisco, CA 94109-8090 | 2016-07-19 |
| 1902127632 | Charles William Green | Nurse Practitioner | 500 Sentara Cir, Suite 102, Williamsburg, VA 23188-5727 | 2010-06-16 |
| 1528283926 | Charles Joseph Green | Orthopaedic Surgery | 2414 Kohler Memorial Dr, Sheboygan, WI 53081-3129 | 2007-04-13 |
| Street Address |
60 HALL STREET |
| City | SUSANVILLE |
| State | CA |
| Zip Code | 96130 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932753456 | Shaughn Randall Whittaker | Nurse Practitioner | 1860 Paul Bunyan Rd, Susanville, CA 96130 | 2019-08-01 |
| 1871980847 | Katie Gaffney | Acupuncturist | 1850 Spring Ridge Dr., Susanville, CA 96130 | 2015-04-17 |
| 1952678435 | Linda Vixie | Dentist | 3020 Johnstonville Rd., Susanville, CA 96130 | 2011-11-28 |
| 1942503057 | Pamela Sue Vallalvazo | Counselor | 1445 Paul Bunyon Rd., Susanville, CA 96130 | 2010-12-10 |
| 1255631883 | Jessica Smyth | Counselor | 1400 Chestnut Street # A, Susanville, CA 96130 | 2010-10-29 |
| 1295045276 | Danielle Hardy | Counselor | 1400 Chestnut Street Suite A, Susanville, CA 96130 | 2010-10-08 |
| 1982921417 | Ronald Spencer Tucker Jr. | Counselor | 4119 Johnstonville Road, #270503, Susanville, CA 96130 | 2010-04-23 |
| 1609107945 | Timothy J Nolan | Psychologist | 803 1/2 Main St., Suite 104, Susanville, CA 96130 | 2010-01-27 |
| 1528243649 | Daniel Martin Bruce | Case Manager/Care Coordinator | 720-a Richmond Road, Susanville, CA 96130 | 2008-01-08 |
| 1679757785 | Michael Charles Giddings | Dentist | 475 Rice Canyon Rd, Susanville, CA 96130 | 2007-12-26 |
| Find all providers in zip 96130 | ||||
| Taxonomy Code | 2085B0100X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Body Imaging |
| A Radiology doctor of Osteopathy that specializes in Body Imaging. |
| Notes: Source: National Uniform Claim Committee, 2008 [7/1/2008: definiton added, source added] Additional Resources: The American Osteopathic Board of Radiology no longer offers a certificate in this specialty. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730795881 | Valerie Rondone | Radiology | 2574 Raleigh Way, El Dorado Hills, CA 95762-6973 | 2020-09-23 |
| 1558997387 | Hope & Trust Trading LLC | Radiology | 318 W Colorado St #2, Glendale, CA 91204 | 2020-03-12 |
| 1417416124 | Adventist Health Physicians Network | Radiology | 155 Solano St Ste 101, Corning, CA 96021-3511 | 2019-03-13 |
| 1770068991 | Reham Aboughali | Radiology | 20349 Anza Ave Apt 27, Torrance, CA 90503-7410 | 2018-10-03 |
| 1962910513 | Excel Imaging Center Inc | Radiology | 13071 Brookhurst St Ste 100, Garden Grove, CA 92843-5514 | 2018-01-17 |
| 1467972315 | Radtech Services Inc | Radiology | 2826 Racine St, Simi Valley, CA 93065-2730 | 2017-06-22 |
| 1619363496 | Nathan Ashley | Radiology | 620 N Bonhill Rd, Los Angeles, CA 90049-2302 | 2015-04-08 |
| 1851709984 | Reveal Diagnostics, LLC | Radiology | 6080 Hellyer Ave, Suite 175, San Jose, CA 95138-1052 | 2014-08-01 |
| 1770912784 | William George Hayden | Radiology | 20 Ciervos Rd, Portola Valley, CA 94028-8107 | 2013-11-11 |
| 1215362942 | Reveal Diagnostics LLC | Radiology | 4217 Piedmont Avenue, Suite B, Oakland, CA 94611 | 2013-09-12 |
| Find all providers with the same taxonomy | ||||
| City | SUSANVILLE |
| Zip Code | 96130 |
Please comment or provide details below to improve the information on CHARLES GARY GREEN.
| 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.