Individual provider Active NPI

Jordan J Glenn, DO

  • Surgery Physician
  • Peoria, AZ
National Provider Identifier
1093008237
Registry record updated Aug 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
006890 Issued in AZ
Practice address
7727 W Deer Valley Rd Ste 220
Peoria, AZ 85382-2121
Phone
(602) 843-8317
Fax
(602) 843-9091
NPI assigned
May 20, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 29, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular Surgery Physician 2086S0129X 006890 AZ
Surgery Physician 208600000X 006890 AZ Primary
Trauma Surgery Physician 2086S0127X 006890 AZ

Addresses

Primary practice location

7727 W Deer Valley Rd Ste 220
Peoria, AZ 85382-2121

Mailing address

7727 W Deer Valley Rd Ste 220
Peoria, AZ 85382-2121
Phone (602) 843-8317

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ, TX2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20160309002977 AZ Practitioner - General Surgery 0749586279 Reassigns benefits to 2 organizations
I20231103000608 TX Practitioner - General Surgery 0749586279 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Arizona College of Osteopathic Medicine Mid Western University, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

7727 W Deer Valley Rd
Suite 220
Peoria, AZ 85382-2121
Phone (602) 831-2142

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hernia repair (minimally invasive)1-10
Varicose vein removal29
Melanoma (skin cancer) excision1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Arizona Advanced Surgery LLC Surgery CurrentSince Apr 1, 2020 Accepting new patients
Foot Specialists of El Paso CurrentSince Oct 5, 2023 Accepting new patients
Jordan J Glenn PLLC Surgery CurrentSince Jul 1, 2025 Accepting new patients

Locations

10238 E Hampton Ave
Ste 107
Mesa, AZ 85209
Phone (480) 354-5829

6750 W Thunderbird Rd
Ste B108
Peoria, AZ 85381
Phone (602) 843-8317

7727 W Deer Valley Rd
Ste 220
Peoria, AZ 85382
Phone (602) 831-2142

2320 N 3rd St
Phoenix, AZ 85004
Phone (602) 258-3262

6559 N Mesa St
El Paso, TX 79912
Phone (915) 584-5683

6330 N Mesa St
Ste F
El Paso, TX 79912

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/IGJBCD

Organizations & group practices 3

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 2

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": "1305849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756425600000",
    "number": "1093008237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7727 W DEER VALLEY RD STE 220",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853822121",
            "telephone_number": "602-843-8317",
            "fax_number": "602-843-8317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7727 W DEER VALLEY RD STE 220",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853822121",
            "telephone_number": "602-843-8317",
            "fax_number": "602-843-9091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLENN",
        "first_name": "JORDAN",
        "middle_name": "J",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-05-20",
        "last_updated": "2025-08-29",
        "certification_date": "2025-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "AZ",
            "license": "006890",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AZ",
            "license": "006890",
            "primary": true
        },
        {
            "code": "2086S0127X",
            "taxonomy_group": "",
            "desc": "Surgery, Trauma Surgery",
            "state": "AZ",
            "license": "006890",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, AZ

Sources for this page

Verify at the official NPI Registry.