Active NPI
Glyn Anne Porter, M.D.
- Anatomic Pathology & Clinical Pathology Physician
- Valparaiso, IN
National Provider Identifier
1114912920
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- 01044317A
- Practice address
- 2901 Pepper Creek Bridge Pkwy
Valparaiso, IN 46385-7127 - Phone
- (219) 405-9950
- Fax
- (219) 464-3873
- NPI assigned
- Sep 19, 2005
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 01044317A | IN | Primary |
Addresses
Primary practice location
2901 Pepper Creek Bridge Pkwy
Valparaiso, IN 46385-7127
Mailing address
2901 Pepper Creek Bridge Pkwy
Valparaiso, IN 46385-7127
Phone (219) 405-9950
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200409510 | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01044317A | IN | MD | Anatomic Pathology & Clinical Pathology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Indiana University Health la Porte Hospital Inc | Past | Accepting new patients |
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.
-
- General Acute Care Hospital
- La Porte, IN
- NPI 1386822989
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127088000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323648000000",
"number": "1114912920",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2901 PEPPER CREEK BRIDGE PKWY",
"city": "VALPARAISO",
"state": "IN",
"postal_code": "463857127",
"telephone_number": "219-405-9950",
"fax_number": "219-464-3873"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2901 PEPPER CREEK BRIDGE PKWY",
"city": "VALPARAISO",
"state": "IN",
"postal_code": "463857127",
"telephone_number": "219-405-9950",
"fax_number": "219-464-3873"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PORTER",
"first_name": "GLYN",
"middle_name": "ANNE",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-09-19",
"last_updated": "2011-12-12",
"status": "A"
},
"taxonomies": [
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "IN",
"license": "01044317A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200409510",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Valparaiso, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.