THEODORE GREEN – Family Nurse Practitioner, NPI 1053954776
Family Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
6,261 NURSE PRACTITIONER in WA
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Provider Addresses for THEODORE GREEN
8 PONCE DE LEON CRK SW
LAKEWOOD, WA 984991746
Phone:
Type: Mailing
3716 PACIFIC AVE STE E
TACOMA, WA 984187836
Phone: (253) 474-5141
Type: Mailing
Pacific Avenue, Tacoma, Pierce County, Washington, 98418-7826, United States
TACOMA, WA 984187836
Phone: (253) 474-5141
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 2 Open Payments records for all available years, with a total value of $9.
Total Amount is formed as General ($9) + Research ($0) + Ownership ($0) = $9.
Last reported payment date: 2023-06-08 • Largest payer in this snapshot: MAYNE PHARMA COMMERCIAL LLC ($9).
Total Amount
$9
General + Research + Ownership
Payments
2
Total payment records
General Amount
$9
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-06-08
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| MAYNE PHARMA COMMERCIAL LLC | $9 |
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: 2020-03-31
PECOS data refreshed: 2026-05-27
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
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20200331000330 | I | Nurse Practitioner | WA | TBD |
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.
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
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 235 | 146 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 127 | 102 | $0 |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 88 | 88 | $0 |
| 83036 | Hemoglobin a1c level | 35 | 22 | $0 |
| 81002 | Urinalysis, manual test | 23 | 22 | $0 |
Insurance plans in this area (ZIP 98499)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | IN | |
| Family Practice | IL | |
| General Practice | WA | |
| - | WA | |
| Nurse Practitioner | MD | |
| Family Practice | OH | |
| Family Practice, Geriatric Medicine | OR | |
| - | WA | |
| Family Practice | WA | |
| Nurse Practitioner | TN |
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