Kelly Rae Glenn, DPM

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

UNKNOWN Issued in CA

Practice address

4150 Clement St
San Francisco, CA 94121-1563

Phone

(415) 221-4810

NPI assigned

Apr 8, 2022

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

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

California School of Podiatric Medicine, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The West Oakland Health CouncilGroup PAC ID 9537062302, 27 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• The West Oakland Health Council

  • Federally Qualified Health Center (FQHC)
  • Oakland, CA
  • NPI 1285754234
  Medicare reassignment Care Compare group
• The West Oakland Health Council

  • Psychiatric/Mental Health Nurse Practitioner
  • Oakland, CA
  • NPI 1043331630

  Single Specialty

  NPD
• The West Oakland Health Council

  • Adult Mental Health Clinic/Center
  • Oakland, CA
  • NPI 1568583789
  NPD

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

{
    "created_epoch": "1649376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649376000000",
    "number": "1104568419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1209 MACARTHUR BLVD",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946102846",
            "telephone_number": "510-421-2056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4150 CLEMENT ST",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941211563",
            "telephone_number": "415-221-4810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLENN",
        "first_name": "KELLY",
        "middle_name": "RAE",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-04-08",
        "last_updated": "2022-04-08",
        "certification_date": "2022-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "CA",
            "license": "UNKNOWN",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shannon Gleason, PTA
• Alice Ann Gleghorn, PH.D.
• Douglas Glen, M.A., M.F.I.
• Denis Joseph Glenn, MD
• John Molloy Glenn III, DO
• Michaela Glenn, MD
• Orit A. Glenn, M.D.
• Arthur Glezer
• James Michael Glick, MD
• Joyce A Glick, DPT

• Foot & Ankle Surgery Podiatrist in San Francisco, CA
• Providers in San Francisco, CA by specialty
• Foot & Ankle Surgery Podiatrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2022; 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.
• 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.