JOHNNY BERT GREEN (NPI# 1386612414) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386612414 |
| Entity Type | Individual |
| Full Name | JOHNNY BERT GREEN |
| Credential | MD |
| Practice Address |
1072 N Liberty Street Suite 201 Boise ID 83704 |
| Mailing Address |
3340 E Goldstone Way Meridian ID 83642-1026 |
| Practice Telephone | 2083022400 |
| Practice Fax Number | 2083022455 |
| Mailing Telephone | 2083022400 |
| Mailing Fax Number | 2083022455 |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2016-11-15 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208600000X | Surgery | 35113 | WA | Allopathic & Osteopathic Physicians |
| Y | 208C00000X | Colon & Rectal Surgery | M-11186 | ID | Allopathic & Osteopathic Physicians |
| N | 208C00000X | Colon & Rectal Surgery | 35113 | WA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | 1386612414 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457726481 | Johnny Green | Counselor | 92 Tennessee Ave, Alexandria, LA 71301-5692 | 2015-12-02 |
| 1831411263 | Johnny Duane Green | Counselor | 105 Plaza, Madill, OK 73446-2248 | 2010-02-26 |
| Street Address |
1072 N LIBERTY STREET SUITE 201 |
| City | BOISE |
| State | ID |
| Zip Code | 83704 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760903363 | Sheev Indravadan Dattani | Surgery | 1072 N Liberty Street, Ste 201, Boise, ID 83704 | 2017-07-05 |
| 1003288648 | Brittany Peeler | Physician Assistant | 1072 N Liberty Street, Ste 303, Boise, ID 83704 | 2015-10-22 |
| 1861861841 | Tess Weidner | Midwife | 1072 N Liberty Street, Ste 100, Boise, ID 83704 | 2015-09-19 |
| 1023404811 | Annis Wakelee Vargas | Pediatrics | 1072 N Liberty Street, Ste 203, Boise, ID 83701 | 2015-04-08 |
| 1194127472 | Anna Hoskins | Physician Assistant | 1072 N Liberty Street, Ste 201, Boise, ID 83704-8708 | 2014-09-18 |
| 1770857021 | Wendi Holmes | Registered Nurse | 1072 N Liberty Street, Ste 100, Boise, ID 83704 | 2012-03-05 |
| 1316258510 | Bradley Grant Bishop | Pediatrics | 1072 N Liberty Street, Ste 203, Boise, ID 83704 | 2010-06-23 |
| 1265651566 | Ondrej Choutka | Neurological Surgery | 1072 N Liberty Street, Ste 303, Boise, ID 83704 | 2007-04-25 |
| 1750430617 | Adrian J Curnow | Surgery | 1072 N Liberty Street, Ste 201, Boise, ID 83704-8708 | 2007-01-09 |
| 1821150285 | Shauna Williams | Colon & Rectal Surgery | 1072 N Liberty Street, Suite 201, Boise, ID 83704 | 2006-12-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215535893 | Laura Diggs | Counselor | 400 North Benjamin Lane, Suite 200, Boise, ID 83704 | 2020-10-15 |
| 1891304002 | Tree City Family Dental | Dentist | 7301 W. Emerald St Ste. 102, Boise, ID 83704 | 2020-07-24 |
| 1982230710 | Jessica Wynn Councell | Midwife | 1072 N Liberty St Ste 100, Boise, ID 83704 | 2020-03-12 |
| 1699307124 | Isabel Burns Bruce | Registered Nurse | 777 N Raymond Street, Boise, ID 83704 | 2020-02-12 |
| 1558903328 | Daring In Idaho, LLC | Social Worker | 413 N Allumbaugh Street, Suite 102, Boise, ID 83704 | 2019-10-14 |
| 1053960286 | Kyle Hiromi Hatanaka | Acupuncturist | 9450 #120 Fairview Avenue, Boise, ID 83704 | 2019-09-10 |
| 1700447141 | Katie Elizabeth Nichols | Physician Assistant | 1072 N Liberty St Ste 201, Boise, ID 83704 | 2019-06-26 |
| 1588164727 | Cory Michael Sims | Counselor | 6550 W. Emerald St #112, Boise, ID 83704 | 2018-02-14 |
| 1477072270 | Matthew Lee Love | Non-emergency Medical Transport (VAN) | 6933 W. Stratton St, Boise, ID 83704 | 2017-09-12 |
| 1942735949 | Dalana Sue Thompson | Counselor | 9196 Emerald St Suite #130, Boise, ID 83704 | 2017-04-27 |
| Find all providers in zip 83704 | ||||
| Taxonomy Code | 208C00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Colon & Rectal Surgery |
| A colon and rectal surgeon is trained to diagnose and treat various diseases of the intestinal tract, colon, rectum, anal canal and perianal area by medical and surgical means. This specialist also deals with other organs and tissues (such as the liver, urinary and female reproductive system) involved with primary intestinal disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Colon and Rectal Surgery, 2007. http://www.abcrs.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Colon and Rectal Surgery. Colon and rectal surgeons have the expertise to diagnose and often manage anorectal conditions such as hemorrhoids, fissures (painful tears in the anal lining), abscesses and fistulae (infections located around the anus and rectum) in the office setting. They also treat problems of the intestine and colon, and perform endoscopic procedures to evaluate and treat problems such as cancer, polyps (precancerous growths) and inflammatory conditions. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821150285 | Shauna Williams | Colon & Rectal Surgery | 1072 N Liberty Street, Suite 201, Boise, ID 83704 | 2006-12-14 |
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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.