Glennetta Coleman, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036067471 Issued in IL

Practice address

1893 Daimler Rd
Rockford, IL 61112-1081

Phone

(815) 227-0055

Fax

(815) 227-0050

NPI assigned

Jun 26, 2006

Sex

Female

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 2

Other names 1

• Glenna Coleman Professional name

Medicare fee-for-service enrollment

Enrolled in IL

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

State licenses

Practice roles

Locations

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.

• Coleman Clinic, Inc.

  • Internal Medicine Physician
  • Rockford, IL
  • NPI 1962002832

  Single Specialty

  NPD Authorized official
• James David Koepsell MD SC

  • Internal Medicine Physician
  • Rockford, IL
  • NPI 1831391424

  Single Specialty

  NPD (past)

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

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722902400000",
    "number": "1063449296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1893 DAIMLER RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611121081",
            "telephone_number": "815-227-0055",
            "fax_number": "815-227-0050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1893 DAIMLER RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611121081",
            "telephone_number": "815-227-0055",
            "fax_number": "815-227-0050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLEMAN",
        "first_name": "GLENNETTA",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-26",
        "last_updated": "2024-08-06",
        "certification_date": "2024-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036067471",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF ILLINOIS",
            "identifier": "0031603167",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036-06741",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GLENNA",
            "last_name": "COLEMAN",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Maria E Coffman, PT
• Timothy P Coggin, M.D.
• James Peter Cole Jr., D.O., F.A.C.S.
• Coleman Clinic, Inc.
• David B Coleman, MD
• Veronica Michell Coleman
• Sarah E Collier, MS
• Carol Jean Collins Burchardt, LCPC
• Chelsea J Collins, RN
• Heather Collman, PT, DPT

• Internal Medicine Physician in Rockford, IL
• Providers in Rockford, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2024; 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.