Derrick Richard Green (NPI# 1952644460, PAC ID# 5597068981) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PATHOLOGY.
| Nation Provider ID (NPI) | 1952644460 |
| PAC ID by PECOS | 5597068981 |
| Professional Enrollment ID | I20181101003348 |
| Full Name | Derrick Richard Green |
| Organization Legal Name | CHARLESTON AREA MEDICAL CENTER, INC. |
| Address |
4111 1st Ave Suite 3 Nitro WV 25143-1345 |
| Phone Number | 3047554797 |
| Gender | M |
| Medical School | UNIVERSITY OF TENNESSEE COLLEGE OF MEDICINE |
| Graduation Year | 2013 |
| Primary Specialty | PATHOLOGY |
| Group Practice PAC ID | 3375441637 |
| Number of Group Practice Members | 512 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 510022 | CHARLESTON AREA MEDICAL CENTER |
| 510091 | CHARLESTON SURGICAL HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 11 Courtney Dr, Charleston, WV 25304-2699 | 3049258521 | CHARLESTON AREA MEDICAL CENTER, INC. |
| 1201 Washington St E, Charleston, WV 25301-1850 | CHARLESTON AREA MEDICAL CENTER, INC. | |
| 13 Courtney Dr, Charleston, WV 25304-2699 | 3049254200 | CHARLESTON AREA MEDICAL CENTER, INC. |
| 3100 Maccorkle Ave Se, Suite 602, Charleston, WV 25304-1231 | 3043885280 | CHARLESTON AREA MEDICAL CENTER, INC. |
| 3200 Maccorkle Ave Se, Charleston, WV 25304-1227 | CHARLESTON AREA MEDICAL CENTER, INC. | |
| 501 Morris St, Charleston, WV 25301-1326 | CHARLESTON AREA MEDICAL CENTER, INC. | |
| 501 Morris St, Fl 2, Charleston, WV 25301-1326 | 3043886301 | CHARLESTON AREA MEDICAL CENTER, INC. |
| 800 Pennsylvania Ave, Charleston, WV 25302-3351 | CHARLESTON AREA MEDICAL CENTER, INC. | |
| 1400 Hospital Dr, Hurricane, WV 25526-9202 | 3047571700 | CHARLESTON AREA MEDICAL CENTER, INC. |
| 4111 1st Ave, Suite 3, Nitro, WV 25143-1345 | 3047554797 | CHARLESTON AREA MEDICAL CENTER, INC. |
| Organization Legal Name | CHARLESTON AREA MEDICAL CENTER, INC. |
| Physicians | 502 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Julie Vannoy | Nurse Practitioner | Charleston Area Medical Center, Inc. | 3860 Teays Valley Rd, Suite 5, Hurricane, WV 25526-9772 |
| William Stewart | Plastic and Reconstructive Surgery | Charleston Area Medical Center, Inc. | 210 Brooks St, Suite 200, Charleston, WV 25301-1848 |
| Marciano B. Lee | Cardiovascular Disease (cardiology) | Charleston Area Medical Center, Inc. | 3200 Maccorkle Ave Se, Charleston, WV 25304-1212 |
| Barry Michael Mitchell | Emergency Medicine | Charleston Area Medical Center, Inc. | 501 Morris St, Charleston, WV 25301-1326 |
| E Michael Robie | Family Medicine | Charleston Area Medical Center, Inc. | 4111 1st Ave, Suite 3, Nitro, WV 25143-1345 |
| David Arthur Felder Jr. | Orthopedic Surgery | Charleston Area Medical Center, Inc. | 1206 Hospital Dr, Hurricane, WV 25526-8708 |
| Justin Varghese | Hospitalist | Charleston Area Medical Center, Inc. | 501 Morris St, Charleston, WV 25301-1326 |
| Sandra R Miles | Certified Registered Nurse Anesthetist (crna) | Charleston Area Medical Center, Inc. | 501 Morris St, Charleston, WV 25301-1326 |
| Victoria Kitts | Certified Registered Nurse Anesthetist (crna) | Charleston Area Medical Center, Inc. | 501 Morris St, Charleston, WV 25301-1326 |
| Teresa M Mazur | Emergency Medicine | Charleston Area Medical Center, Inc. | 501 Morris St, Charleston, WV 25301-1326 |
| Street Address |
4111 1ST AVE SUITE 3 |
| City | NITRO |
| State | WV |
| Zip | 25143-1345 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| E Michael Robie | Family Medicine | Charleston Area Medical Center, Inc. | 4111 1st Ave, Suite 3, Nitro, WV 25143-1345 |
| Joanna B Stover | Physician Assistant | Charleston Area Medical Center, Inc. | 4111 1st Ave, Suite 3, Nitro, WV 25143-1345 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Jay Lee Mcclanahan | Chiropractic | 642 Cross Lanes Dr, Nitro, WV 25143-1163 | |
| Sarah Y Taylor | Optometry | Taylor Eye Associates, Pllc | 3802 38th St, Nitro, WV 25143-1641 |
| Travis Lee Taylor | Optometry | Taylor Eye Associates, Pllc | 3802 38th St, Nitro, WV 25143-1641 |
| Elizabeth Ann Parsons | Optometry | Taylor Eye Associates, Pllc | 3802 38th St, Nitro, WV 25143-1641 |
| Tracy L Leege | Nurse Practitioner | Ths Physician Partners Inc | 6 A Bank St, Nitro, WV 25143-1708 |
| Lisa R Mallory | Nurse Practitioner | Ths Physician Partners Inc | 6 A Bank St, Nitro, WV 25143-1708 |
| Angela D Whitman | Family Medicine | Ths Physician Partners Inc | 6 A Bank St, Nitro, WV 25143-1708 |
| Andrea Dawn Moses | Nurse Practitioner | Ths Physician Partners Inc | 6 A Bank St, Nitro, WV 25143-1708 |
| Melisa Jane Snodgrass | Physician Assistant | Ths Physician Partners Inc | 6 A Bank St, Nitro, WV 25143-1708 |
| Gregory Mark Moreland | Family Medicine | 2206 22nd St, Nitro, WV 25143-1729 | |
| Find all physicians in zip 25143 | |||
| City | NITRO |
| Zip Code | 25143 |
| Specialty | PATHOLOGY |
| City + Specialty | NITRO + PATHOLOGY |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.