Physician Compare National (NPI:1205875804)

HEALTHCARE PROVIDER: JOHN MARSHALL GREEN MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1205875804
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	4981892999
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20101222000122
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GREEN
	Individual professional last name
Provider First Name	JOHN
	Individual professional first name
Provider Middle Name	M
	Individual professional middle name
Provider Name Suffix Text	JR.
	The name suffix of the provider if the provider is an individual. The name suffix is a ''generation-related'' suffix, such as Jr., Sr., II, III, IV, or V.
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF ARKANSAS COLLEGE OF MEDICINE
	Individual professional's medical school
Graduation Year	1980
	Individual professional's medical school graduation year
Primary Specialty	PHYSICAL MEDICINE AND REHABILITATION
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	OUR LADY OF THE LAKE PHYSICIAN GROUP LLC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	4587849781
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	502
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	5000 HENNESSY BLVD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 3
	Group Practice or individual's line 2 address
City	BATON ROUGE
	Group Practice or individual's city
State	LA
	Group Practice or individual's state
Zip Code	708084375
	Group Practice or individual's zip code (9 digits when available)
Phone Number	2257658987
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y