Physician Compare National (NPI:1619947629)

HEALTHCARE PROVIDER: GREENE BUTLER M.D.

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

Individual Professional Information
NPI	1619947629
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	8022083971
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100330001374
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	BUTLER
	Individual professional last name
Provider First Name	GREENE S
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	LOUISIANA STATE UNIVERSITY SCHOOL OF MEDICINE IN SHREVEPORT
	Individual professional's medical school
Graduation Year	1981
	Individual professional's medical school graduation year
Primary Specialty	GENERAL SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	GREEN CLINIC 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	4789668831
	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	60
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	411 E VAUGHN AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 201
	Group Practice or individual's line 2 address
City	RUSTON
	Group Practice or individual's city
State	LA
	Group Practice or individual's state
Zip Code	712705977
	Group Practice or individual's zip code (9 digits when available)
Phone Number	3182321570
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	191315
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	HARDTNER MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	190086
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	NORTHERN LOUISIANA MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 2
Professional Accepts Medicare Assignment	Y