Glass Dermatology PLLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

Legal business name

GLASS DERMATOLOGY PLLC

Practice address

412 E Johnson St
Clinton, NC 28328-2806

Phone

(910) 490-1240

Fax

(910) 490-1260

NPI assigned

May 24, 2021

Organization subpart

No

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

Authorized official

Name

Alexandria B Glass, DONPI 1174916365

Title

Physician/Owner

Phone

(910) 990-7722

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Interoperability endpoints

• FHIR API: https://app.meldrx.com/api/fhir/ez_00139

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Alexandria Bass Glass, D.O.

  • Dermatology Physician
  • Clinton, NC
  • NPI 1174916365
  Medicare reassignment Care Compare group NPD Authorized official
• Lauren Burke, PA-C

  • Physician Assistant
  • Clinton, NC
  • NPI 1356148001
  Medicare reassignment Care Compare group NPD
• Matthew James Hewetson, PA-C

  • Physician Assistant
  • Clinton, NC
  • NPI 1891588125
  Medicare reassignment Care Compare group
• Andrea C Villareal, PA-C

  • Physician Assistant
  • Wilmington, NC
  • NPI 1730337130
  Medicare reassignment
• Ann-Marie Llanes, PA-C

  • Physician Assistant
  • Parrish, FL
  • NPI 1851767875

  NC

  Medicare reassignment

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

{
    "created_epoch": "1621814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646352000000",
    "number": "1184299034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "412 E JOHNSON ST",
            "city": "CLINTON",
            "state": "NC",
            "postal_code": "283282806",
            "telephone_number": "910-490-1240",
            "fax_number": "910-490-1260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 E JOHNSON ST",
            "city": "CLINTON",
            "state": "NC",
            "postal_code": "283282806",
            "telephone_number": "910-490-1240",
            "fax_number": "910-490-1260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLASS DERMATOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-24",
        "last_updated": "2022-03-04",
        "certification_date": "2022-03-04",
        "status": "A",
        "authorized_official_last_name": "GLASS",
        "authorized_official_first_name": "ALEXANDRIA",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "910-990-7722",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NC MEDICAL LICENSE",
            "identifier": "202101095",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael A Galletti, D.O.
• Gateway to Better Help, LLC
• Mary Katrina Snyder Gaylord, MD
• Ryan S Geist
• Crystal Gillis, FNP
• Alexandria Bass Glass, D.O.
• Glover Transport LLC
• Rolf Peter Gobien, M.D.
• Golden Opportunity Homes, Inc
• Goshen Medical Center Incorporated

• Medical Specialty Clinic/Center in Clinton, NC
• Providers in Clinton, NC by specialty
• Medical Specialty Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.