Mark William Glass

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA02857 Issued in TX

Practice address

17051 Dallas Pkwy Ste 400
Addison, TX 75001-7108

Phone

(214) 370-3535

Fax

(214) 370-0004

NPI assigned

Aug 18, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ortholonestar PLLCGroup PAC ID 9931529062, 416 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mark.glass.1@15533.direct.athenahealth.com
• Direct secure messaging: mglass@direct.uspi.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ortholonestar, PLLC

  • Orthopaedic Surgery Physician
  • Houston, TX
  • NPI 1942860176
  Medicare reassignment Care Compare group NPD
• Ortholonestar, PLLC

  • Orthopaedic Surgery Physician
  • Tomball, TX
  • NPI 1073475679
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1013021161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5927 E UNIVERSITY BLVD APT 221",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752069114",
            "telephone_number": "214-926-7117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17051 DALLAS PKWY STE 400",
            "city": "ADDISON",
            "state": "TX",
            "postal_code": "750017108",
            "telephone_number": "214-370-3535",
            "fax_number": "214-370-0004"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9301 N Central Expy Ste 500",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "752310805",
            "country_code": "US",
            "telephone_number": "214-220-2468",
            "fax_number": "214-720-1982",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GLASS",
        "first_name": "MARK",
        "middle_name": "WILLIAM",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-18",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TX",
            "license": "PA02857",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "209276607",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE  PIN",
            "identifier": "806N48",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Vesha Gibson, LPC-A
• Donna Bennett Gill, LPC
• Glenwood Anesthesia Management
• Golbandi Dentistry PLLC
• Pouya Golbandi, DDS
• Ashkahn Edward Golshani, MD
• Taylor Gonnerman, PT, DPT

• Surgical Physician Assistant in Addison, TX
• Providers in Addison, TX by specialty
• Surgical Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.