Glenn Gary Robertson, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

33045 Issued in AZ

Practice address

1069 S Highway 80
Benson, AZ 85602-7008

Phone

(520) 720-6226

Fax

(877) 795-9311

NPI assigned

Aug 8, 2006

Last updated

Mar 10, 2016By the provider in NPPES

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 1

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.

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: grobertson@yourcarecommunity.org
• FHIR API: https://api.platform.athenahealth.com/17334/brand/1/csg/1/fhir/r4

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.

• Glenn Robertson, MD PLLC

  • Internal Medicine Physician
  • Benson, AZ
  • NPI 1043684558
  NPD (past) Authorized official
• Progressive Healthcare Group Inc

  • Family Medicine Physician
  • Benson, AZ
  • NPI 1083735799
  NPD (past)

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1457568000000",
    "number": "1174533509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1069 S HIGHWAY 80",
            "city": "BENSON",
            "state": "AZ",
            "postal_code": "856027008",
            "telephone_number": "520-720-6226",
            "fax_number": "877-795-9311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1069 S HIGHWAY 80",
            "city": "BENSON",
            "state": "AZ",
            "postal_code": "856027008",
            "telephone_number": "520-720-6226",
            "fax_number": "877-795-9311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "GLENN",
        "middle_name": "GARY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-08",
        "last_updated": "2016-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AZ",
            "license": "33045",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "883753",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Progressive Healthcare Group Inc
• Quiburi Mission Nursing & Rehabilitation LLC
• King Richard Randell, LPC, CADAC, ICADC
• Meena Rao, MD
• Joseph G Rizza, MD
• Pamela J Roller, RN
• Safeway Inc (Safeway Pharmacy #1275)
• San Pedro Family Care, PLC
• Rebecca Joy Satter, ARNP
• Philip Schneider, RN

• Internal Medicine Physician in Benson, AZ
• Providers in Benson, AZ by specialty
• Internal Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2016; 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.