Glenn G Petty, D.P.M.

Primary specialty

PodiatristTaxonomy code 213E00000X

License

180 Issued in AR

Practice address

5510 Summerhill Rd
Texarkana, TX 75503-1822

Phone

(903) 792-2710

Fax

(903) 831-7357

NPI assigned

Jun 16, 2006

Sex

Male

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 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

State licenses

Practice roles

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.

• East Texas Medical Center Healthcare Associates

  • Emergency Medicine Physician
  • Tyler, TX
  • NPI 1326082892
  NPD (past)
• Orthodomicile

  • Podiatrist
  • Texarkana, TX
  • NPI 1245665306
  NPD (past)

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1217894400000",
    "number": "1104861160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6579",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755056579",
            "telephone_number": "870-863-7080",
            "fax_number": "903-792-3286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5510 SUMMERHILL RD",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755031822",
            "telephone_number": "903-792-2710",
            "fax_number": "903-831-7357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTY",
        "first_name": "GLENN",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "D.P.M.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-16",
        "last_updated": "2008-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "AR",
            "license": "180",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "018576101",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD-TX",
            "identifier": "P00349253",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "134175717",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD-AR",
            "identifier": "P00129576",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Heather Pennington, RNFA
• Helen Elizabeth Pennington, RPH
• Carlos Luis Perez, MD
• Permian Premier Health Services Inc
• Edward Charles Perry, LPC
• PG Pharmacy Inc.
• Hong Phuc Pham
• Hung Pham
• Tri Duc Pham, RPH
• Brittany Phelps

• Podiatrist in Texarkana, TX
• Providers in Texarkana, TX by specialty
• Podiatrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.