Individual provider Active NPI

Jon Ryan Glass, M.D.

  • Urology Physician
  • Marrero, LA
National Provider Identifier
1174522577
Registry record updated Jan 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
025041 Issued in LA
Practice address
1111 Medical Center Blvd
S-650
Marrero, LA 70072-3151
Phone
(504) 934-8100
Fax
(504) 934-8102
NPI assigned
Jul 18, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 025041 LA Primary

Addresses

Primary practice location

1111 Medical Center Blvd
S-650
Marrero, LA 70072-3151

Mailing address

1111 Medical Center Blvd
S-650
Marrero, LA 70072-3151
Phone (504) 934-8100

Other identifiers 1

IdentifierTypeStateIssuer
1046761MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20050825000034 LA Practitioner - Urology 2264463702 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Tulane University School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New Orleans Physician Services IncGroup PAC ID 5294057824, 177 clinicians

Practice addresses (Care Compare)

1101 Medical Ctr Blvd
Marrero, LA 70072-3147
Phone (504) 349-2427

1101 Medical Ctr Blvd ER
Marrero, LA 70072-3147
Phone (504) 349-1533

4513 Westbank Expressway
Marrero, LA 70072
Phone (504) 349-6360

Hospital & facility affiliations

  • West Jefferson Medical Center Hospital, Marrero, LA, CCN 190039
  • New Orleans East Hospital Hospital, New Orleans, LA, CCN 190313

Merit-based Incentive Payment System (MIPS)

Final score
78.64 of 100Reported as group
Quality
68.02
Improvement activities
40
Cost
76.01

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
025041LAMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
New Orleans Physician Services Inc Urology CurrentSince Oct 1, 2014 Accepting new patients
Westside Dermatology Associates a Professional Medical Corporation PastSince Jan 1, 1995 Accepting new patients
The Administrators of the Tulane Educational Fund Past Accepting new patients
Administrators of the Tulane Educational Fund Past Accepting new patients

Locations

2845 Manhattan Blvd
Harvey, LA 70058
Phone (504) 349-6930

1111 Medical Center Blvd
Ste N311
Marrero, LA 70072
Phone (504) 349-6507

1101 Medical Center Blvd
Marrero, LA 70072
Phone (504) 347-5511

1111 Medical Center Blvd
Ste S650
Marrero, LA 70072
Phone (504) 349-6504

1111 Medical Center Blvd
Ste N703
Marrero, LA 70072
Phone (504) 349-4901

Organizations & group practices 4

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.

Hospital & facility affiliations 3

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": "1121644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1389916800000",
    "number": "1174522577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 MEDICAL CENTER BLVD",
            "address_2": "S-650",
            "city": "MARRERO",
            "state": "LA",
            "postal_code": "700723151",
            "telephone_number": "504-934-8100",
            "fax_number": "504-934-8102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 MEDICAL CENTER BLVD",
            "address_2": "S-650",
            "city": "MARRERO",
            "state": "LA",
            "postal_code": "700723151",
            "telephone_number": "504-934-8100",
            "fax_number": "504-934-8102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLASS",
        "first_name": "JON",
        "middle_name": "RYAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-18",
        "last_updated": "2014-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "LA",
            "license": "025041",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1046761",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marrero, LA

Sources for this page

Verify at the official NPI Registry.