NICOLE E GREEN (PA-C) – Medical Physician Assistant, NPI 1053873786

NICOLE E GREEN (PA-C) is a healthcare provider. based in Bel air, Maryland. specializing in PHYSICIAN ASSISTANT. They hold the professional credentials PA-C. They hold a License No. C0007198 (MD). The NPI Number for NICOLE E GREEN (PA-C) is 1053873786

Main info

Female
7 Years Of Experience
Accepts Medicare Assignment
Name
NICOLE E GREEN (PA-C)
NPI
1053873786
Phone
(443) 643-1500
Address
500 UPPER CHESAPEAKE DR
Enumeration Date
2 April 2019
Last Update Date
3 November 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
4436433130
Graduation Year
2019 (7 years ago)
PAC ID
1557794138
Group Practice PAC ID
4880879162
Professional Enrollment ID
I20191212001966
Address ID
MD210144336BE510XXDRXX404
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience38
Completeness75
Years active:7State licenses:1Digital endpointsOther names

3,391 PHYSICIAN ASSISTANT in MD

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Provider Addresses for NICOLE E GREEN (PA-C)

  • University of Maryland Upper Chesapeake Medical Center, 500, Upper Chesapeake Drive, Wakefield Manor, Bel Air, Harford County, Maryland, 21014, United States

    BEL AIR, MD 210144324

    Phone: (443) 643-1500

    Fax: (443) 643-1505

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 9 Open Payments records for all available years, with a total value of $236.

Total Amount is formed as General ($236) + Research ($0) + Ownership ($0) = $236.

Last reported payment date: 2024-05-01 • Largest payer in this snapshot: Baxter Healthcare ($55).

Total Amount

$236

General + Research + Ownership

Payments

9

Total payment records

General Amount

$236

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-05-01

Latest reported date

View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2019-12-12

PECOS data refreshed: 2026-06-15

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20191212001966IPhysician AssistantMDTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99222Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes1313$0
View full utilization report →

Insurance plans in this area (ZIP 21014)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 4880879162View full group profile
NameSpecialtyState
Physician AssistantMD
Physician AssistantMD
Orthopedic SurgeryMD
Orthopedic SurgeryMD
Orthopedic SurgeryMD
Nurse PractitionerPA
Physician AssistantMD

Reviews

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Frequently asked questions

What number should I use to identify NICOLE E GREEN (PA-C) for billing?
Administrative and clinical systems typically use NPI 1053873786 for NICOLE E GREEN (PA-C).
Does the public listing show NICOLE E GREEN (PA-C) as active?
NICOLE E GREEN (PA-C)'s NPI record reflects an active status in NPPES.
What services align with NICOLE E GREEN (PA-C)'s listing?
NICOLE E GREEN (PA-C)'s public classification highlights Medical Physician Assistant. Clinical services aligned with this taxonomy classification.
What city is tied to NICOLE E GREEN (PA-C)?
The directory associates NICOLE E GREEN (PA-C) with Bel Air, Maryland. Check all listed addresses for suites or satellite offices.
Can I export NICOLE E GREEN (PA-C)'s record?
You can download the official NPPES record; we summarize key fields for readability.

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