Glen Gormezano, M.D.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

G58609 Issued in CA

Practice address

3875 Telegraph Ave
Oakland, CA 94609-2428

Phone

(510) 547-2244

NPI assigned

Oct 2, 2006

Last updated

Sep 25, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Ambulatory Consultants Medical Group Inc

  • Anesthesiology Physician
  • Oakland, CA
  • NPI 1437178563
  Medicare reassignment NPD

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569369600000",
    "number": "1225121189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 398398",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941398398",
            "telephone_number": "888-991-1101",
            "fax_number": "903-787-5854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3875 TELEGRAPH AVE",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946092428",
            "telephone_number": "510-547-2244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORMEZANO",
        "first_name": "GLEN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2019-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "G58609",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachel Gorham, MED CHILD DEV
• Suzanne Catherine Gorham, MFT
• Maggie Gori
• Jodi Gorman, APRN, FNP
• Sharon Lynn Gorman, PT, DPTSC, GCS
• Phillip Gorrindo, M.D., PH.D.
• Leslie Gortemiller
• Sonja Aline Goss
• Caryn Jill Gottcent, NPF
• Judith B. Gottlieb

• Anesthesiology Physician in Oakland, CA
• Providers in Oakland, CA by specialty
• Anesthesiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2019; 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.

Verify at the official NPI Registry.