NPIMap

Individual provider Active NPI

Glenn T. Etzel, M.D.

  • Family Medicine Physician
  • Price, UT
National Provider Identifier
1083727408
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
821690231205 Issued in UT
Practice address
230 N Hospital Dr
Suite 5
Price, UT 84501-4221
Phone
(435) 637-9545
Fax
(435) 637-3423
NPI assigned
Aug 17, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 821690231205 UT Primary

Addresses

Primary practice location

230 N Hospital Dr
Suite 5
Price, UT 84501-4221

Mailing address

PO Box 882
Price, UT 84501-0882
Phone (435) 636-0625

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address medreview@reverehealth.com Revere Health PC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050624000814 UT Practitioner - Family Practice 9032154547 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Creighton University School of Medicine, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Revere Health PCGroup PAC ID 7517868508, 407 clinicians

Practice addresses (Care Compare)

230 N Hospital Dr
Suite 5
Price, UT 84501-4222
Phone (435) 637-9545

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
821690231205UTMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Castleview Physician Practices, LLC CurrentSince Oct 30, 2017 Accepting new patients
Castleview Hospital, LLC CurrentSince Jun 2, 2020 Accepting new patients
Castleview Hospital, LLC Family Medicine Current Accepting new patients
Castleview Physician Practice LLC Current Accepting new patients
Revere Health PC CurrentSince Jul 1, 2007 Accepting new patients
Revere Health PC CurrentSince Jul 1, 2007 Accepting new patients

Locations

230 N Hospital Dr
Ste 5
Price, UT 84501
Phone (435) 637-9545

300 N Hospital Dr
Price, UT 84501
Phone (435) 636-4836

1055 N 500 W
Ste 212
Provo, UT 84604
Phone (801) 374-2362

1055 N 500 W
Provo, UT 84604
Phone (801) 429-8000

Interoperability endpoints

  • Direct secure messaging: glennetzel@cuccu.allscriptsdirect.net
  • Direct secure messaging: csu9689@yourcarecommunity.org

Organizations & group practices 6

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.

Hospital & facility affiliations 9

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

NPI Registry JSON

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1083727408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 882",
            "city": "PRICE",
            "state": "UT",
            "postal_code": "845010882",
            "telephone_number": "435-636-0625",
            "fax_number": "435-637-4448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 N HOSPITAL DR",
            "address_2": "SUITE 5",
            "city": "PRICE",
            "state": "UT",
            "postal_code": "845014221",
            "telephone_number": "435-637-9545",
            "fax_number": "435-637-3423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETZEL",
        "first_name": "GLENN",
        "middle_name": "T.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-17",
        "last_updated": "2023-11-27",
        "certification_date": "2020-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "821690231205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "medreview@reverehealth.com",
            "affiliation": "Y",
            "affiliationName": "Revere Health PC",
            "address_1": "230 N Hospital Dr",
            "address_2": "SUITE 5",
            "city": "Price",
            "state": "UT",
            "country_code": "US",
            "postal_code": "845014221",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Price, UT

Sources for this page

Verify at the official NPI Registry.