Bradley Holman Glenn, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD-21314 Issued in HI

Practice address

85 Maui Lani Pkwy
Wailuku, HI 96793-2416

Phone

(808) 244-5366

NPI assigned

Jun 6, 2017

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 names 1

• Dr. Bradley Keith Holman Former name

Medicare fee-for-service enrollment

Enrolled in HI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles (1 of 4)

Locations

Networks

• HI PPO
• Optimum HealthCare HMO Network
• devoted network organization-c89d4c14-e90f-4cf7-83f9-456527a52335

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.

• Glenn Family Medicine, LLC

  • Family Medicine Physician
  • Wailuku, HI
  • NPI 1508443805

  Family Medicine, HI

  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• B.C.P., Inc.

  • Home Health Agency
  • Wailuku, HI
  • NPI 1942569702
  Care Compare affiliation
• Maui Health System a Kaiser Foundation Hospitals LLC

  • General Acute Care Hospital
  • Wailuku, HI
  • NPI 1013379460

  Hospital

  Care Compare affiliation

Specialty

Family Practice

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Glenn Family Medicine, LLC 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Bayada Home Health Care Home health agency, Wailuku, HI, CCN 127309
• Maui Memorial Medical Center Hospital, Wailuku, HI, CCN 120002

Procedures performed for Medicare patients

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

{
    "created_epoch": "1496707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630540800000",
    "number": "1043749872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "85 MAUI LANI PKWY",
            "city": "WAILUKU",
            "state": "HI",
            "postal_code": "967932416",
            "telephone_number": "808-244-5366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 MAUI LANI PKWY",
            "city": "WAILUKU",
            "state": "HI",
            "postal_code": "967932416",
            "telephone_number": "808-244-5366"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "221 Mahalani St",
            "address_purpose": "LOCATION",
            "city": "Wailuku",
            "state": "HI",
            "postal_code": "967932526",
            "country_code": "US",
            "telephone_number": "808-244-9056",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GLENN",
        "first_name": "BRADLEY",
        "middle_name": "HOLMAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-06",
        "last_updated": "2021-09-02",
        "certification_date": "2021-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "HI",
            "license": "MD-21314",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BRADLEY",
            "last_name": "HOLMAN",
            "middle_name": "KEITH",
            "prefix": "DR.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Scott Girardelli
• Giron Corporation
• Leslie Hartley Gise, MD
• Raymond M. Glauser, OD
• Glenn Family Medicine, LLC
• Travis Wagner Glenn, MD
• Kyra R Glover, OTR/L
• Nicholas Scott Goehner, M.D.
• Heather E Goff, MD
• Margaret E. Goldberg, LCSW, CSAC

• All providers in Wailuku, HI
• Family Medicine Physician in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2021; 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.