1. Home
  2. Directory
  3. Michigan
  4. Grand Rapids
  5. Nurse Practitioner
  6. NPI Profile

ETHAN THOMAS GREEN
NPI 1609547702
Nurse Practitioner in Grand Rapids, MI

Active since September 28, 2021PECOS EnrolledAccepts Medicare Assignment
300 68TH ST SE, GRAND RAPIDS, MI 49548(616) 455-5000(616) 281-6459 Get Directions Write a Review

NPPES record last updated: October 3, 2021. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Ethan Thomas Green NPPES

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

ETHAN THOMAS GREEN (NPI 1609547702) is an individual nurse practitioner in Grand Rapids, Michigan, licensed in Michigan (4704318670) and active in the NPI registry since September 2021. He is enrolled in Medicare PECOS and is a graduate of Other (2021).

NPPES Registry Identity

NPI1609547702
Entity TypeIndividualMale
Primary Taxonomy363L00000X
Provider Legal NameETHAN THOMAS GREEN
Location Address300 68TH ST SEGrand Rapids, MI 49548-6927
Mailing Address300 68th St SeGrand Rapids, MI 49548-6927 · (616) 455-5000 · Fax (616) 281-6459
Phone(616) 455-5000
Fax(616) 281-6459
Sole ProprietorNo
Medical School CMSOtherGraduated 2021
Enumeration DateSeptember 28, 2021
Last NPPES UpdateOctober 3, 2021
NPPES CertifiedOctober 3, 2021
✔ NPI 1609547702 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363L00000X
License✔ Licensed in MI · 4704318670
Definition
(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.
300 68TH ST SE, Grand Rapids, MI 49548
Open in Google Maps ↗

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health and more.Insurance ›

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Ethan Thomas Green is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID3577952845
PECOS Enrollment IDI20211109000586
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 Ethan Green reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Pine Rest Christian Mental Health Services
Same address
Nurse Practitioner
300 68TH ST SE
Grand Rapids, MI 49548
  • Reassigned Medicare billing, Michigan enrollment
  • 41 clinicians in this Medicare group
NPI 1467463604 (616) 455-5000

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

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
57 services19 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
23 services15 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 49548 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
$84.74 typical visit price
range $54.34 – $166.68
Typical copayment $21.18 (range $13.58 – $41.67)
Most-billed visit code 99203
Established Patient
$96.44 typical visit price
range $17.09 – $135.40
Typical copayment $24.11 (range $4.27 – $33.85)
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.

JILLIAN LEIGH MURRAY L.C.S.W
Social Worker (Clinical)
300 68TH ST SE
GRAND RAPIDS, MI 49548
Kent County (616) 455-5000
CANDY MCKENNEY
Social Worker
300 68TH ST SE
GRAND RAPIDS, MI 49548
Kent County (616) 455-5000
TAO CHANCE BROWN-EDWARDS
Behavior Analyst
300 68TH ST SE
GRAND RAPIDS, MI 49548
Kent County (616) 455-5000
MRS. REBECCA JOY BACK LMSW
Social Worker (Clinical)
300 68TH ST SE
GRAND RAPIDS, MI 49548
Kent County (269) 929-7342
SARA RENE QUASHNIE LLMSW
Social Worker
300 68TH ST SE
GRAND RAPIDS, MI 49548
Kent County (616) 455-5000
KIMERA RAIN HARRIS
Psychiatry & Neurology (Psychiatry)
300 68TH ST SE
GRAND RAPIDS, MI 49548
Kent County (800) 678-5500
AMY LOUISE MCGAREY MSW
Social Worker (Clinical)
300 68TH ST SE
GRAND RAPIDS, MI 49548
Kent County (616) 455-5000
JUNE BUIKEMA-TEBEAU
Counselor (Mental Health)
300 68TH ST SE
GRAND RAPIDS, MI 49548
Kent County (616) 455-5000

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 Ethan Green's NPI number?

The NPI number for Ethan Green is 1609547702. It was assigned to this individual provider in the NPPES registry on September 28, 2021.

Where is Ethan Green located?

Ethan Green practices at 300 68th St SE, Grand Rapids, MI 49548. The listed phone number is (616) 455-5000.

What is Ethan Green's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Is Ethan Green enrolled in Medicare?

Yes. Ethan Green is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Ethan Green's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Ethan Green reassigns Medicare benefits to Pine Rest Christian Mental Health Services (Grand Rapids, MI). 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 Ethan Green's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Ethan Green accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian, Blue Care Network of Michigan and Blue Cross Blue Shield of Michigan Mutual Insurance Company and 1 other insurer list Ethan Green as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Ethan Green was last updated on October 3, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.