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SKYLINE MEDICINE
NPI 1356523492
Clinic/Center in Mesa, AZ

Active since November 30, 2007CLIA 03D1056672 · Waiver
6112 E BROWN RD, MESA, AZ 85205(480) 924-4422 Get Directions Write a Review

NPPES record last updated: March 8, 2012. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Skyline Medicine NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SKYLINE MEDICINE (NPI 1356523492) is a healthcare organization registered as a clinic/center in Mesa, Arizona and active in the NPI registry since November 2007. The organization holds a CLIA Waiver certificate valid through July 20, 2028 and lists Kerry Green, Owner, as its authorized official.

NPPES Registry Identity

NPI1356523492
Entity TypeOrganization
Primary Taxonomy261Q00000X
Legal Business NameKERRY S GREEN MD PLC
Location Address6112 E BROWN RDMesa, AZ 85205-4955
Mailing Address6112 E Brown RdMesa, AZ 85205-4955 · (480) 924-4422
Phone(480) 924-4422
Organization SubpartNo
Authorized OfficialKerry GreenOwner · (480) 924-4422
Enumeration DateNovember 30, 2007
Last NPPES UpdateMarch 8, 2012
✔ NPI 1356523492 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/CenterAmbulatory Health Care Facilities
Taxonomy Code261Q00000X
License✔ Licensed in AZ · 29662
Definition
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
6112 E BROWN RD, Mesa, AZ 85205
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Other Names 1

Doing Business AsSkyline Medicine

Other Identifiers 2

Medicare PINZ75605AZ
Medicare PINDA7145AZ

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Skyline Medicine is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Skyline Medicine, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.

Clinicians, nearest first (2)

Kerry Green, M.D.
Family Practice
NPI 1801835350
6112 E BROWN RD
Mesa, AZ 85205
(480) 924-4422
✔ PECOS✔ Accepts MedicareSame address
Stephen Thomas, M.D.
Internal Medicine
NPI 1508849985
6112 E BROWN RD
Mesa, AZ 85205
(480) 924-4422
✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 03D1056672

Skyline Medicine · Mesa, AZ
Active · expires Jul 20, 2028
CLIA Number03D1056672
Laboratory TypePhysician Office
Certificate Effective DateJuly 21, 2026
Certificate Expiration DateJuly 20, 2028
Laboratory DirectorStephen L. Thomas
Laboratory Phone(480) 924-4422
Laboratory LocationSkyline Medicine6112 E Brown Rd, Mesa, AZ 85205
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kerry S Green MD Plc's NPI number?

The NPI number for Kerry S Green MD Plc is 1356523492. It was assigned to this organization in the NPPES registry on November 30, 2007. The provider is doing business as Skyline Medicine.

Where is Kerry S Green MD Plc located?

Kerry S Green MD Plc is located at 6112 E Brown Rd, Mesa, AZ 85205. The listed phone number is (480) 924-4422.

What is Kerry S Green MD Plc's specialty?

The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.

Is Kerry S Green MD Plc enrolled in Medicare?

Yes. Kerry S Green MD Plc is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Kerry S Green MD Plc?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Kerry S Green MD Plc, in Family Practice and Internal Medicine. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Kerry S Green MD Plc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 03D1056672) is associated with this NPI, valid through July 20, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Kerry S Green MD Plc was last updated on March 8, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.