Glenn Acord Deyo, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

MD00026258 Issued in WA

Practice address

4521 82ND Avenue CT W
University Place, WA 98466-2325

Phone

(253) 312-8336

Fax

(253) 475-1185

NPI assigned

Aug 30, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in ME

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

Specialty

General Surgery

Education

University of Texas Medical School at Houston, 1982

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Penobscot Valley HospitalGroup PAC ID 8426942889, 14 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Penobscot Valley Hospital Hospital, Lincoln, ME, CCN 201303
• Northern Light Eastern Maine Medical Center Hospital, Bangor, ME, CCN 200033

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: glenn.deyo.1@5664.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/5664/brand/1/csg/1/fhir/r4
• FHIR API: https://fhir-usa.unify.chbase.com/org/penob-eadbba22

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.

• Penobscot Valley Hospital

  • Critical Access Hospital
  • Lincoln, ME
  • NPI 1093716086
  Medicare reassignment Care Compare group NPD
• Penobscot Valley Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Lincoln, ME
  • NPI 1700805868
  NPD

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

• Eastern Maine Medical Center

  • General Acute Care Hospital
  • Bangor, ME
  • NPI 1790789147
  Care Compare affiliation
• Penobscot Valley Hospital

  • Critical Access Hospital
  • Lincoln, ME
  • NPI 1093716086
  Care Compare affiliation

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312502400000",
    "number": "1053421800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4521 82ND AVENUE CT W",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "984662325",
            "telephone_number": "253-312-8336",
            "fax_number": "253-475-1185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4521 82ND AVENUE CT W",
            "city": "UNIVERSITY PLACE",
            "state": "WA",
            "postal_code": "984662325",
            "telephone_number": "253-312-8336",
            "fax_number": "253-475-1185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEYO",
        "first_name": "GLENN",
        "middle_name": "ACORD",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2011-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WA",
            "license": "MD00026258",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7030539",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1054279",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "DE2889",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L & I",
            "identifier": "0054140",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amaya Del Solar Morrell
• Sydney Morgan Perez Dela Rosa, MA
• Andrea Delong, ARNP
• Alessandra Denardo
• Jocelyn Devita, MD
• Sapna Dharmar, MD
• Sarah Diamond, MS, MPH, CN
• Christine Marie Diedrich, RN
• Erin Dietz, LAC
• Nichole Margit Dillahunty, LMP

• Surgery Physician in University Place, WA
• Providers in University Place, WA by specialty
• Surgery Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2011; 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.