Individual provider Active NPI

Glenn Pacis, FNP-C

  • Family Nurse Practitioner
  • Leonardo, NJ
National Provider Identifier
1124880174
Registry record updated Jan 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
26NJ14995700 Issued in NJ
Practice address
21 Constitution Dr
Leonardo, NJ 07737-1808
Phone
(732) 668-2738
NPI assigned
Jan 25, 2024
Last updated
Jan 25, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 26NJ14995700 NJ Primary

Addresses

Primary practice location

21 Constitution Dr
Leonardo, NJ 07737-1808

Mailing address

21 Constitution Dr
Leonardo, NJ 07737-1808
Phone (732) 668-2738

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240724002407 NJ Practitioner - Nurse Practitioner 5496726358 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hospitalist Physicians of New Jersey PAGroup PAC ID 3476859927, 162 clinicians

Practice addresses (Care Compare)

1 Riverview PLZ
Red Bank, NJ 07701-1864
Phone (732) 741-2700

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
26NJ14995700NJMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Hospitalist Physicians of New Jersey PA CurrentSince Sep 7, 2024 Accepting new patients

Locations

65 James St
Edison, NJ 08820
Phone (732) 321-7010

727 N Beers St
Holmdel, NJ 07733
Phone (732) 714-2700

1 Riverview Plz
Red Bank, NJ 07701
Phone (732) 530-2204

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

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": "1706140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706140800000",
    "number": "1124880174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 CONSTITUTION DR",
            "city": "LEONARDO",
            "state": "NJ",
            "postal_code": "077371808",
            "telephone_number": "732-668-2738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 CONSTITUTION DR",
            "city": "LEONARDO",
            "state": "NJ",
            "postal_code": "077371808",
            "telephone_number": "732-668-2738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PACIS",
        "first_name": "GLENN",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-01-25",
        "last_updated": "2024-01-25",
        "certification_date": "2024-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NJ",
            "license": "26NJ14995700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Leonardo, NJ

Sources for this page

Verify at the official NPI Registry.