Brian Joseph Glen, DO

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

2022026389 Issued in MO

Practice address

5301 Veterans Memorial Pkwy
Ste 104
Saint Peters, MO 63376-2298

Phone

(636) 939-3362

Fax

(636) 939-3687

NPI assigned

Mar 19, 2019

Last updated

Apr 18, 2025By the provider in NPPES

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 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MO

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 Osteopathy

Practice roles

Locations

Networks

• IA HMO C-SNP
• IA HMO

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

• SSM Health Care St Louis

  dba SSM Health St Clare Fenton

  • Emergency Medicine Physician
  • Fenton, MO
  • NPI 1275586174
  Medicare reassignment NPD
• Wuca - Cloverleaf Pediatrics, LLC

  • Pediatrics Physician
  • Saint Peters, MO
  • NPI 1710375928
  Medicare reassignment NPD
• SSM Cardinal Glennon Childrens Hospital

  dba SSM Health Cardinal Glennon Children's Hospital

  • Pediatrics Physician
  • O'Fallon, IL
  • NPI 1174577670

  MO

  Medicare reassignment NPD
• SSM Cardinal Glennon Children's Hospital

  dba SSM Health Cardinal Glennon Pediatrics

  • Pediatrics Physician
  • Warrenton, MO
  • NPI 1962573212
  NPD
• SSM Health Care St. Louis

  dba SSM Health DePaul Hospital

  • Cardiovascular Disease Physician
  • Bridgeton, MO
  • NPI 1376598599
  NPD

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

{
    "created_epoch": "1552953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744934400000",
    "number": "1043779044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7412025",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606742025",
            "telephone_number": "636-939-3362",
            "fax_number": "636-939-3687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5301 VETERANS MEMORIAL PKWY",
            "address_2": "STE 104",
            "city": "SAINT PETERS",
            "state": "MO",
            "postal_code": "633762298",
            "telephone_number": "636-939-3362",
            "fax_number": "636-939-3687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLEN",
        "first_name": "BRIAN",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-19",
        "last_updated": "2025-04-18",
        "certification_date": "2022-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MO",
            "license": "2022026389",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200070414",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "5301 Veterans Memorial Pkwy",
            "address_2": "STE 104",
            "city": "Saint Peters",
            "state": "MO",
            "country_code": "US",
            "postal_code": "633762298",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Sharon Gillardi, CRNA
• Donette A Gillespie, RPH
• Give Kids a Smile, Inc
• Jeffrey S Glaser, MD
• Shane Michael Gleaves, PA-C
• Glenfield Memory Care Homes
• Dane A. Glueck, MD
• Matthew Scott Godwin, D.C.
• Kayla Marie Goeke, DPT
• Golden Years Center, Inc

• Pediatrics Physician in Saint Peters, MO
• Providers in Saint Peters, MO by specialty
• Pediatrics Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2025; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.