Jennifer Nicole Green, NP-C is a medicare enrolled "Nurse Practitioner - Family" in Louin, Mississippi. Her current practice location is
2421 County Road 16, Louin, Mississippi. You can reach out to her office (for appointments etc.) via phone at
(931) 384-8212.
Jennifer Nicole Green is licensed to practice in Mississippi (license number 903916) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1073064242.
Provider's Profile
| Full Name | Jennifer Nicole Green |
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| Gender | Female |
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| Speciality | Nurse Practitioner - Family |
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| Location | 2421 County Road 16, Louin, Mississippi |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1073064242
- Provider Enumeration Date: 10/21/2016
- Last Update Date: 01/04/2023
Medicare PECOS Information:
- PECOS PAC ID: 5294012555
- Enrollment ID: I20170516000177
Medical Identifiers
Medical identifiers for Jennifer Nicole Green such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1073064242 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 363LF0000X | Nurse Practitioner - Family | 22027 (Tennessee) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | 903916 (Mississippi) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Jennifer Nicole Green allows following entities to bill medicare on her behalf.
| Entity Name | Maury Regional Medical Group, Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1205886264
PECOS PAC ID: 7911810742
Enrollment ID: O20040227000252 |
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| Entity Name | High Forest Health Group |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1326392135
PECOS PAC ID: 5395998959
Enrollment ID: O20130109000613 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jennifer Nicole Green is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Jennifer Nicole Green, NP-C
500 W 190th St Ste 400,
Gardena, CA 90248-4290
Ph: () - | Jennifer Nicole Green, NP-C
2421 County Road 16,
Louin, MS 39338-3230
Ph: (931) 384-8212 |
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