Organization Active NPI

Glomar Medical Nwa PLLC

  • Family Medicine Physician
  • Rogers, AR
National Provider Identifier
1063286177
Registry record updated Nov 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
GLOMAR MEDICAL NWA PLLC
Practice address
4305 S Pleasant Crossing Blvd Ste 103
Rogers, AR 72758-1347
Phone
(800) 511-2747
Fax
(501) 255-9109
NPI assigned
Nov 9, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2023

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

Authorized official

Name
Jan Chesney
Title
Billing Manager
Phone
(317) 796-9785

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

4305 S Pleasant Crossing Blvd Ste 103
Rogers, AR 72758-1347

Mailing address

4305 S Pleasant Crossing Blvd Ste 103
Rogers, AR 72758-1347
Phone (800) 511-2747

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231227002592 AR Part B Supplier - Clinic/Group Practice 4183074578 Receives reassigned benefits from 2 practitioners
Practice locations: Rogers, AR

National Provider Directory

National Provider Directory

Locations

4305 S Pleasant Crossing Blvd
Ste 103
Rogers, AR 72758
Phone (918) 625-5403

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1699488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699488000000",
    "number": "1063286177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4305 S PLEASANT CROSSING BLVD STE 103",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727581347",
            "telephone_number": "800-511-2747",
            "fax_number": "501-255-9109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4305 S PLEASANT CROSSING BLVD STE 103",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727581347",
            "telephone_number": "800-511-2747",
            "fax_number": "501-255-9109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLOMAR MEDICAL NWA PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-09",
        "last_updated": "2023-11-09",
        "certification_date": "2023-11-09",
        "status": "A",
        "authorized_official_last_name": "CHESNEY",
        "authorized_official_first_name": "JAN",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "317-796-9785"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rogers, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.