DR. DEMETRIS ALLEN GREEN SR. (NPI# 1699973420) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699973420 |
| Entity Type | Individual |
| Full Name | DR. DEMETRIS ALLEN GREEN SR. |
| Credential | MD |
| Practice Address |
2646 S Loop W Suite 440 Houston TX 77054-2665 |
| Practice Telephone | 7138089658 |
| Practice Fax Number | 2815013075 |
| Mailing Telephone | 7138089658 |
| Mailing Fax Number | 2815013075 |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2012-08-05 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | J4168 | TX | Allopathic & Osteopathic Physicians |
| Y | 208D00000X | General Practice | J4168 | TX | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | 2817272 | 05 |
| Street Address |
2646 S LOOP W SUITE 440 |
| City | HOUSTON |
| State | TX |
| Zip Code | 77054-2665 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790783819 | Newchannel Incorporated | Durable Medical Equipment & Medical Supplies | 2646 S Loop W, Suite 270 & 270a, Houston, TX 77054-2665 | 2005-07-12 |
| 1174166904 | Brenda Thomas | Nurse Practitioner | 2646 S Loop W, Houston, TX 77054-2665 | 2019-10-24 |
| 1912550112 | Alozie Bright Amayaka | Nurse Practitioner | 2646 S Loop W, Houston, TX 77054-2665 | 2019-07-17 |
| 1124477336 | Siblings Healthcare Solutions LLC | Home Health | 2646 S Loop W, Suite 355, Houston, TX 77054-2665 | 2016-06-08 |
| 1013366335 | Tmc Pain Surgical Center | Clinic/Center | 2646 S Loop W, Suite 140, Houston, TX 77054-2665 | 2016-06-07 |
| 1982079307 | Pediatric Executives | Pediatrics | 2646 S Loop W, Suite 400, Houston, TX 77054-2665 | 2015-12-10 |
| 1053785097 | Ken Pratt | Pediatrics | 2646 S Loop W, Suite 400, Houston, TX 77054-2665 | 2015-11-13 |
| 1740678770 | Demetris A. Green, Sr. Md Pa | Family Medicine | 2646 S Loop W, Suite 220, Houston, TX 77054-2665 | 2014-12-29 |
| 1710384920 | Prestige Transportation Services | Non-emergency Medical Transport (VAN) | 2646 S Loop W, 505g, Houston, TX 77054-2665 | 2014-12-03 |
| 1356746200 | Sunset Labs, LLC | Clinical Medical Laboratory | 2646 S Loop W, Suite 665, Houston, TX 77054-2665 | 2014-11-04 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467006924 | Sphinx Pharmacy Group Webster Inc | Pharmacy | 2656 S Loop W Suite 275, Houston, TX 77054 | 2019-08-01 |
| 1164076618 | Pearland Unicare Pharmacy LLC | Pharmacy | 7400 Fannin Street Suite 120, Houson, TX 77054 | 2019-08-01 |
| 1144873092 | Megan Hoenig | Genetic Counselor, MS | 2525-a Holly Hall St., Suite 3c, Houston, TX 77054 | 2019-07-19 |
| 1043781701 | Lisa Vercellino Salazar | Nurse Practitioner | The Woman's Hospital of Texas, 7600 Fannin, Houston, TX 77054 | 2018-12-06 |
| 1619447257 | Karee Harris | Specialist/Technologist, Other | 7400 Fannin St Suite 850 Tx, Houston, TX 77054 | 2018-11-27 |
| 1245715374 | Van Hoai Thi Hoang | Pharmacist | 2525a Holly Hall, Houston, TX 77054 | 2018-09-25 |
| 1093294639 | Yolanda Williams-vasquez | Licensed Vocational Nurse | 3131 W Bellfort Ave, Houston, TX 77054 | 2018-08-13 |
| 1104304542 | Reji Mammen | Dentist | 2120 El Paseo St., Apt 2607, Houston, TX 77054 | 2018-07-28 |
| 1912484825 | Saeed Yazdianpour | Dentist | 7600 Cambridge St, Houston, TX 77054 | 2018-07-24 |
| 1811480742 | Dominik Andrzej Rudecki | Student in an Organized Health Care Education/Training Program | 7500 Cambridge St, Suite 6510, Houston, TX 77054 | 2018-06-14 |
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| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376151472 | Canice Chukwuocha | General Practice | 3030 Elmside Dr Apt 179, Houston, TX 77042-3926 | 2020-07-15 |
| 1902424518 | Medkare | General Practice | 2426 Lake Kolbe Ln, Houston, TX 77080-2562 | 2020-07-09 |
| 1477191757 | Holistic Innovative Interventional Pain Associates Pllc | General Practice | 4615 Southwest Freeway #850, Houston, TX 77027 | 2019-12-17 |
| 1467019109 | Eldere Germain | General Practice | 5850 Duxbury St, Houston, TX 77035-4211 | 2019-05-28 |
| 1235697822 | Joy Ileruwa Ebomwonyi | General Practice | 17567 Imperial Valley Dr, Houston, TX 77060-7706 | 2019-03-04 |
| 1194295030 | Westheimer Medical Group Pllc | General Practice | 5433 Westheimer Rd Ste 275, Houston, TX 77056-5331 | 2018-12-04 |
| 1538639638 | Clear Mind Agency LLC | General Practice | 1300 N Post Oak Rd, Houston, TX 77055-5431 | 2018-11-30 |
| 1346739158 | Abc Solutions Group Corp | General Practice | 10333 Harwin Dr Ste 530l, Houston, TX 77036-1545 | 2018-05-07 |
| 1073018768 | V & V Medical Management | General Practice | 13626 Veterans Memorial Dr Ste F, Houston, TX 77014 | 2018-03-26 |
| 1942703525 | Victor Yosef Melt Campos | General Practice | 1220 W Pierce St, Houston, TX 77019-4146 | 2018-03-09 |
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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.