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OTIS GREEN
NPI 1497326300
Emergency Medicine in Jacksonville, FL

Active since July 02, 2021PECOS Enrolled
4201 BELFORT RD, JACKSONVILLE, FL 32216(904) 296-3700 Get Directions Write a Review

NPPES record last updated: March 30, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Mar 30, 2026, Jul 2, 2021 (2 updates tracked since 2021).

About Otis Green NPPES

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

OTIS GREEN (NPI 1497326300) is an individual emergency medicine provider in Jacksonville, Florida, licensed in Florida (ME180065) and active in the NPI registry since July 2021. He is enrolled in Medicare PECOS, is affiliated with Ascension St Vincent's Riverside, and maintains 6 additional practice locations.

NPPES Registry Identity

NPI1497326300
Entity TypeIndividualMale
Primary Taxonomy207P00000X
Provider Legal NameOTIS GREEN
Location Address4201 BELFORT RDJacksonville, FL 32216-1431
Mailing Address1601 Cummins Dr Ste DModesto, CA 95358-6411
Phone(904) 296-3700
Sole ProprietorNo
Medical School CMSMorehouse School Of MedicineGraduated 2022
Enumeration DateJuly 2, 2021
Last NPPES UpdateMarch 30, 20262 updates tracked since enumeration
NPPES CertifiedMarch 30, 2026
✔ NPI 1497326300 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyEmergency MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207P00000X
License✔ Licensed in FL · ME180065
Definition
An emergency physician focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. The emergency physician provides immediate recognition, evaluation, care, stabilization and disposition of a generally diversified population of adult and pediatric patients in response to acute illness and injury.
4201 BELFORT RD, Jacksonville, FL 32216
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Secondary Practice Locations 6

Location 18083 Parramore RdJacksonville, FL 32244-5703 · Phone (904) 450-6760
Location 2205 Trinity WaySaint Johns, FL 32259-1155 · Phone (904) 450-8120
Location 39820 Hutchinson Park DrJacksonville, FL 32225-7205 · Phone (904) 450-8120
Location 41670 St Vincents WayMiddleburg, FL 32068-8447 · Phone (904) 602-1000
Location 51 Shircliff WayJacksonville, FL 32204-4748 · Phone (904) 308-7000
Location 6720 Westview Dr SWAtlanta, GA 30310-1458 · Phone (404) 752-1500

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

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

PECOS PAC ID4789064429
PECOS Enrollment IDI20260327004150
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Otis Green reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Cep America LLC
Same address
Emergency Medicine
4201 BELFORT RD
Jacksonville, FL 32216
  • Reassigned Medicare billing, Florida enrollment
  • 367 clinicians in this Medicare group
NPI 1346937331 (904) 296-3700

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

Hospital Affiliations CMS Care Compare 4

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Ascension St Vincent's Riverside

Acute Care Hospitals · Jacksonville, FL
2/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number100040
Location1 Shircliff WayJacksonville, FL 32204 · Duval County
Emergency services

Baptist Health Medical Center - Jacksonville

Acute Care Hospitals · Jacksonville, FL
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number100088
Location800 Prudential DrJacksonville, FL 32207 · Duval County
Emergency services Birthing friendly

Ascension St Vincent's Southside

Acute Care Hospitals · Jacksonville, FL
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number100307
Location4201 Belfort RdJacksonville, FL 32216 · Duval County
Emergency services Birthing friendly

Ascension St Vincent's Clay County

Acute Care Hospitals · Middleburg, FL
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number100321
Location1670 St Vincents WayMiddleburg, FL 32068 · Clay County
Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 32216 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$87.62 typical visit price
range $56.00 – $171.84
Typical copayment $21.90 (range $14.00 – $42.96)
Most-billed visit code 99203
Established Patient
$99.16 typical visit price
range $17.57 – $139.16
Typical copayment $24.79 (range $4.39 – $34.79)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JENNIFER L. MAUZY MD
Emergency Medicine
4201 BELFORT RD
JACKSONVILLE, FL 32216
Duval County (904) 296-3885
ELIZABETH SANTIAGO PHARMD
Pharmacist
4201 BELFORT RD
JACKSONVILLE, FL 32216
Duval County (904) 296-3771
ANDREW BRIAN KIRKLAND
Physician Assistant
4201 BELFORT RD
JACKSONVILLE, FL 32216
Duval County (904) 296-3784
PULMONARY AND CRITICAL CARE ASSOCIATES P A
Internal Medicine (Pulmonary Disease)
4201 BELFORT RD
JACKSONVILLE, FL 32216
Duval County (904) 366-3738
HAYDEN HELLER CRPS
Peer Specialist
4201 BELFORT RD
JACKSONVILLE, FL 32216
Duval County (904) 296-3700
DR. KELVIN JAMES WILEY M.D.
Specialist
4201 BELFORT RD
JACKSONVILLE, FL 32216
Duval County (803) 718-6251
DR. MICHAEL GORDON MAXWELL M.D.
Emergency Medicine
4201 BELFORT RD
JACKSONVILLE, FL 32216
Duval County (904) 296-3700
DR. MAE M COLEMAN MD
Pediatrics (Neonatal-Perinatal Medicine)
4201 BELFORT RD
JACKSONVILLE, FL 32216
Duval County (904) 296-3700

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 Otis Green's NPI number?

The NPI number for Otis Green is 1497326300. It was assigned to this individual provider in the NPPES registry on July 2, 2021.

Where is Otis Green located?

Otis Green practices at 4201 Belfort Rd, Jacksonville, FL 32216. The listed phone number is (904) 296-3700.

What is Otis Green's specialty?

The primary specialty registered for this NPI is Emergency Medicine with taxonomy code 207P00000X.

Is Otis Green enrolled in Medicare?

Yes. Otis Green is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Otis Green's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Otis Green reassigns Medicare benefits to Cep America LLC (Jacksonville, FL). The 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 Otis Green's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

Is Otis Green affiliated with any hospitals?

According to CMS data, Otis Green is affiliated with Ascension St Vincent's Riverside, Baptist Health Medical Center - Jacksonville, Ascension St Vincent's Southside and Ascension St Vincent's Clay County.

When was this NPI record last updated?

The NPPES record for Otis Green was last updated on March 30, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 months 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.