Individual provider Active NPI

Glenn Stewart Herman, DC

  • Sports Physician Chiropractor
  • Naugatuck, CT
National Provider Identifier
1093826752
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Physician ChiropractorTaxonomy code 111NS0005X
License
708 Issued in CT
Practice address
331 Church St
Naugatuck, CT 06770-2806
Phone
(203) 729-4047
Fax
(203) 723-9103
NPI assigned
Aug 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Physician Chiropractor 111NS0005X 708 CT Primary

Addresses

Primary practice location

331 Church St
Naugatuck, CT 06770-2806

Mailing address

331 Church St
Naugatuck, CT 06770-2806
Phone (203) 729-4047

Other identifiers 2

IdentifierTypeStateIssuer
004092508MedicaidCT
050000708CT01OtherCTANTHEM BLUE CROSS/BLUE SH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111019000817 CT Practitioner - Chiropractic 6901081140 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
New York Chiropractic College, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Palmer Herman Chiropractic Physicians LLCGroup PAC ID 1052596459, 2 clinicians

Practice addresses (Care Compare)

331 Church St
Naugatuck, CT 06770-2806
Phone (203) 729-4047

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
708CTMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Palmer Herman Chiropractic Physicians LLC CurrentSince Jul 1, 1988 Accepting new patients

Locations

331 Church St
Naugatuck, CT 06770
Phone (203) 729-4047

Interoperability endpoints

  • Direct secure messaging: glenn@pcpl0001.direct.chirotouch.md

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1093826752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "331 CHURCH ST",
            "city": "NAUGATUCK",
            "state": "CT",
            "postal_code": "067702806",
            "telephone_number": "203-729-4047",
            "fax_number": "203-723-9103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "331 CHURCH ST",
            "city": "NAUGATUCK",
            "state": "CT",
            "postal_code": "067702806",
            "telephone_number": "203-729-4047",
            "fax_number": "203-723-9103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERMAN",
        "first_name": "GLENN",
        "middle_name": "STEWART",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "CT",
            "license": "708",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004092508",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS/BLUE SH",
            "identifier": "050000708CT01",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Naugatuck, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.