Active NPI
Glenn Charles Meyers, RPA-C
- Physician Assistant
- Bay Shore, NY
National Provider Identifier
1174615348
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 002950
- Practice address
- 301 E Main St
Bay Shore, NY 11706-8408 - Phone
- (631) 968-3000
- NPI assigned
- Sep 28, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 002950 | NY | Primary |
Addresses
Primary practice location
301 E Main St
Bay Shore, NY 11706-8408
Mailing address
301 E Main St
Bay Shore, NY 11706-8408
Phone (631) 968-3000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002950 | NY | MD | Hospitalist Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159401600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1191888000000",
"number": "1174615348",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 E MAIN ST",
"city": "BAY SHORE",
"state": "NY",
"postal_code": "117068408",
"telephone_number": "631-968-3000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 E MAIN ST",
"city": "BAY SHORE",
"state": "NY",
"postal_code": "117068408",
"telephone_number": "631-968-3000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEYERS",
"first_name": "GLENN",
"middle_name": "CHARLES",
"name_prefix": "Mr.",
"credential": "RPA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-28",
"last_updated": "2007-10-09",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "002950",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bay Shore, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2007; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.