Glenn L Robertson, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

372285-1205 Issued in UT

Practice address

2380 N 400 E Ste a
North Logan, UT 84341-1756

Phone

(435) 554-3240

Fax

(435) 554-3241

NPI assigned

Mar 30, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in UT, ID, WY3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 3

Specialty

Family Practice

Education

Eastern Virginia Medical School, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

San Juan County HospitalGroup PAC ID 4486541851, shared by 5 NPIs, 19 clinicians

Ogden Clinic PCGroup PAC ID 9638078033, 104 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Cache Valley Hospital Hospital, North Logan, UT, CCN 460054
• Moab Regional Hospital Hospital, Moab, UT, CCN 461302
• San Juan Hospital Hospital, Monticello, UT, CCN 461308
• Intermountain Health Logan Regional Hospital Hospital, Logan, UT, CCN 460015

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/d2bc3d5a-3c39-4553-86b1-b3aa0a5429a7/

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.

• Ogden Clinic PC

  • Family Medicine Physician
  • Ogden, UT
  • NPI 1578550083
  Medicare reassignment Care Compare group NPD
• Affinity Healthcare, Inc.

  • Family Medicine Physician
  • Logan, UT
  • NPI 1144928854
  Medicare reassignment NPD
• Moab Valley Healthcare, Inc

  • Critical Access Hospital
  • Moab, UT
  • NPI 1770513236

  Family Medicine

  Medicare reassignment NPD
• San Juan County Hospital

  • Rural Health Clinic/Center
  • Monticello, UT
  • NPI 1659315877

  Family Medicine

  Medicare reassignment NPD
• San Juan County Hospital

  • Critical Access Hospital
  • Monticello, UT
  • NPI 1942251459
  Medicare reassignment NPD
• Bear Lake Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Garden City, UT
  • NPI 1689754475
  Medicare reassignment
• Bear Lake Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Brigham City, UT
  • NPI 1558806125
  NPD
• Moab Valley Healthcare, Inc.

  • Community/Retail Pharmacy
  • Moab, UT
  • NPI 1235918962
  NPD
• Moab Valley Healthcare, Inc.

  • Methadone Clinic
  • Moab, UT
  • NPI 1285380394
  NPD
• San Juan County Hospital

  • Emergency Care Clinic/Center
  • Monticello, UT
  • NPI 1114121100
  NPD
• San Juan County Hospital

  • Rural Health Clinic/Center
  • Spanish Valley, UT
  • NPI 1588978738

  Family Medicine

  NPD
• Moab Valley Healthcare Inc

  • Certified Registered Nurse Anesthetist
  • Moab, UT
  • NPI 1700857398
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Ihc Health Services Inc

  • General Acute Care Hospital
  • Logan, UT
  • NPI 1831108497
  Care Compare affiliation
• Moab Valley Healthcare, Inc

  • Critical Access Hospital
  • Moab, UT
  • NPI 1770513236
  Care Compare affiliation
• Moab Valley Healthcare, Inc.

  • Methadone Clinic
  • Moab, UT
  • NPI 1285380394

  Hospital

  Care Compare affiliation
• Mountain Division - CVH, LLC

  • General Acute Care Hospital
  • North Logan, UT
  • NPI 1952703472
  Care Compare affiliation
• San Juan County Hospital

  • Critical Access Hospital
  • Monticello, UT
  • NPI 1942251459
  Care Compare affiliation

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

{
    "created_epoch": "1143676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738108800000",
    "number": "1144281122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5546",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802175546",
            "telephone_number": "801-475-3500",
            "fax_number": "801-475-3414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2380 N 400 E STE A",
            "city": "NORTH LOGAN",
            "state": "UT",
            "postal_code": "843411756",
            "telephone_number": "435-554-3240",
            "fax_number": "435-554-3241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "GLENN",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-30",
        "last_updated": "2025-01-29",
        "certification_date": "2025-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M-14903",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WY",
            "license": "12808A",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101246275",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "372285-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samuel Harris Pond, LCSW
• Bryan Neal Porter, D.D.S.
• Primary Care Pediatrics
• Jeffrey J Pulley, PA-C
• Robert S. Cook, PH.D., PC
• Zachary Robinett, M.D.
• Kira Robinson, CSW
• Heidi Joan Robison, CFY-SLP
• Rocky Mountain Dermatology Inc
• Kaitlin Ruth Rodgers

• Family Medicine Physician in North Logan, UT
• Providers in North Logan, UT by specialty
• Family Medicine Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2025; 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.