MRS. TEDEAN KARISSA GREEN
NPI 1699122630
Student in an Organized Health Care Education/Training Program in Detroit, MI
About Mrs. Tedean Karissa Green NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MRS. TEDEAN KARISSA GREEN (NPI 1699122630) is an individual student in an organized health care education/training program in Detroit, Michigan and active in the NPI registry since May 2016. She is enrolled in Medicare PECOS and is a graduate of Loma Linda University School Of Medicine (2016).
NPPES Registry Identity
Specialties & Licenses
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
Mrs. Tedean Karissa 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.
Medicare Billing Reassignment
Medicare enrollment records show Tedean Green reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Lancaster, CA 93534
- Reassigned Medicare billing, California enrollment
- 13,921 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Other Providers at the Same Location NPPES 6
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
DETROIT, MI 48201
DETROIT, MI 48201
DETROIT, MI 48201
DETROIT, MI 48201
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 Tedean Green's NPI number?
The NPI number for Tedean Green is 1699122630. It was assigned to this individual provider in the NPPES registry on May 19, 2016.
Where is Tedean Green located?
Tedean Green practices at 4201 Saint Antoine St # Uhc Department Of Otolaryngology-Head And Neck Surgery, Detroit, MI 48201. The listed phone number is (269) 924-9783.
What is Tedean Green's specialty?
The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.
Is Tedean Green enrolled in Medicare?
Yes. Tedean 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 Tedean Green's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Tedean Green reassigns Medicare benefits to Southern California Permanente Medical Group (Lancaster, CA). 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 Tedean Green's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
When was this NPI record last updated?
The NPPES record for Tedean Green was last updated on July 1, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.
# Mrs. Tedean Karissa Green · NPI 1699122630
Student in an Organized Health Care Education/Training Program provider in Detroit, Michigan. Individual provider, active in the CMS NPPES registry since May 19, 2016.
## Identity
- **NPI:** 1699122630 (Entity type: Individual)
- **Enumerated:** May 19, 2016
- **Primary specialty:** Student in an Organized Health Care Education/Training Program · taxonomy 390200000X
- **Sole proprietor:** No
## Practice location
- **Address:** 4201 SAINT ANTOINE ST # UHC, DEPARTMENT OF OTOLARYNGOLOGY-HEAD AND NECK SURGERY, Detroit, MI 48201-2153
- **Phone:** (269) 924-9783
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Southern California Permanente Medical Group (NPI 1982863783, Lancaster, CA), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Loma Linda University School Of Medicine, class of 2016
## Record status
- **NPPES last updated:** July 1, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1699122630) · Data from the CMS NPPES public registry.