Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
NPIDirectory

Ethan Thomas Green

Individual provider Nurse Practitioner · NPI 1609547702

Ethan Thomas Green is a Nurse Practitioner in Grand Rapids, Michigan. Qualified in 2021, 5 years ago. Practices with Pine Rest Christian Mental Health Services, a 353-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Michigan.

Years since qualifying
5
Licensed in
MI
In the registry since
2021
Claim this listing Report a problem Suggest an edit

Practice location Address checks out

300 68th St SE
Grand Rapids, MI 49548-6927
Phone: (616) 455-5000
Fax: (616) 281-6459
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence 4704318670 (MI)

Record details

NPI number1609547702
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedSeptember 28, 2021
Last updated in NPPESOctober 3, 2021
Certification dateOctober 3, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Pine Rest Christian Mental Health Services — 353 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

Medicare patients and services, 2024

From the CMS Medicare Physician & Other Practitioners file for calendar year 2024. It counts Original Medicare patients only, so a practice that mostly sees Medicare Advantage or privately insured patients looks smaller here than it is.

Medicare patients38
Services billed 85 a service is one billed item, such as a visit, a test or a procedure
Average patient age59

Dollar amounts are not shown. What Medicare pays a practice is gross billings, before staff, premises and tax and including the cost of any drugs it administers, so it is not what a clinician earns.

Colleagues at Pine Rest Christian Mental Health Services

Clinicians the CMS Doctors & Clinicians file lists under the same group practice. CMS counts 353 clinicians in the practice; 12 are shown here.

Other providers in Grand Rapids