JERRIL GREEN (NPI# 1457441016) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1457441016 |
| Entity Type | Individual |
| Full Name | JERRIL GREEN |
| Credential | MD |
| Practice Address |
14319 Saint Michael Dr Little Rock AR 72211-5572 |
| Practice Telephone | 5015902885 |
| Mailing Telephone | 5015902885 |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2014-11-12 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080P0203X |
Pediatrics Specialization: Pediatric Critical Care Medicine |
E-1961 | AR | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AR | 135223001 | 05 |
| Street Address |
14319 SAINT MICHAEL DR |
| City | LITTLE ROCK |
| State | AR |
| Zip Code | 72211-5572 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760004618 | Samantha Lenore Hilborn | Behavior Technician | 1525 Merrill Drive Suite 100, Little Rock, AR 72211 | 2020-05-14 |
| 1003437740 | Centers for Youth and Families, Inc. | Community/Behavioral Health | 1521 Merrill Drive, Suite D220 and E200, Little Rock, AR 72211 | 2020-05-05 |
| 1962040568 | Erica N Taylor | Nurse Practitioner | 11800 Financial Center Parkway, Ste 290, Little Rock, AR 72211 | 2019-12-13 |
| 1568932119 | Katie Jones | Nurse Practitioner | 1children's Way, Little Rock, AR 72211 | 2018-11-27 |
| 1356828651 | Kayleigh King | Dietitian, Registered | 4 Shackleford Plz Ste 209, Little Rock, AR 72211 | 2018-07-19 |
| 1699283838 | Kara Elizabeth Simmons | Physician Assistant | 11215 Hermitage Rd Ste 103, Little Rock, AR 72211 | 2018-01-22 |
| 1194241463 | Wendy Newsam Pllc | Counselor | 1 Innwood Circle, Suite 107, Little Rock, AR 72211 | 2017-08-18 |
| 1861915159 | Sarah Renee Beall | Counselor | 10800 Financial Centre #290, Little Rock, AR 72211 | 2017-07-19 |
| 1457873127 | Restore Hope Counseling Center, Pllc | Counselor | One Innwood Circle, Suite 201, Little Rock, AR 72211 | 2017-07-13 |
| 1447707500 | University of Arkansas for Medical Sciences | Durable Medical Equipment & Medical Supplies | 601 Autumn Road, Little Rock, AR 72211 | 2016-09-07 |
| Find all providers in zip 72211 | ||||
| Taxonomy Code | 2080P0203X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Critical Care Medicine |
| A pediatrician expert in advanced life support for children from the term or near-term neonate to the adolescent. This competence extends to the critical care management of life-threatening organ system failure from any cause in both medical and surgical patients and to the support of vital physiological functions. This specialist may have administrative responsibilities for intensive care units and also facilitates patient care among other specialists. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source added] Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. ACGME Accredited Residency Program Requirements: 2 years of training with 3 years Pediatrics plus 1 year Pediatric Critical Care for certification for a total of 6 years. ABMS Approved Subspecialty Certificate (Pediatrics) |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891808713 | Ronald C Sanders Jr. | Pediatrics | 1 Childrens Way # 512-12, Little Rock, AR 72202-3500 | 2006-08-16 |
| 1730687450 | Mary Lynne Shults | Pediatrics | 1 Childrens Way # 653, Little Rock, AR 72202-3500 | 2018-01-28 |
| 1255637070 | Jeremy Garlick | Pediatrics | 1 Childrens Way, Little Rock, AR 72202-3500 | 2011-01-27 |
| 1346475498 | Abdallah Riad Dalabih | Pediatrics | 1 Childrens Way # 653, Little Rock, AR 72202-3500 | 2009-05-19 |
| 1295969632 | Matthew Phillip Malone | Pediatrics | 1 Childrens Way, Slot #512-12, Little Rock, AR 72202-3500 | 2009-05-13 |
| 1134321961 | Rupal Tansukhlal Bhakta | Pediatrics | 1 Childrens Way # 512-3, Little Rock, AR 72202-3500 | 2007-06-04 |
| 1871712109 | Melina Chan | Pediatrics | 4301 W Markham St # 783, Little Rock, AR 72205-7101 | 2007-04-25 |
| 1306968284 | Michael Hugh Stroud | Pediatrics | 4301 W Markham St # 783, Little Rock, AR 72205-7101 | 2007-04-04 |
| 1639269293 | Debra Fiser | Pediatrics | 800 Marshall St # 653, Little Rock, AR 72202-3510 | 2006-10-13 |
| 1366532921 | Mark Heulitt | Pediatrics | 800 Marshall St # 653, Little Rock, AR 72202-3510 | 2006-10-13 |
| Find all providers in LITTLE ROCK | ||||
| City | LITTLE ROCK |
| Zip Code | 72211 |
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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.