Individual provider Active NPI

Loretto Glynn, M.D.

  • Pediatric Surgery Physician
  • Mineola, NY
National Provider Identifier
1235111014
Registry record updated Apr 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Surgery PhysicianTaxonomy code 2086S0120X
License
036-083709 Issued in IL
Practice address
259 1St St
Mineola, NY 11501-3957
Phone
(516) 663-4600
NPI assigned
Nov 16, 2005
Last updated
Apr 28, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Surgery Physician 2086S0120X 35914 OK
Pediatric Surgery Physician 2086S0120X 036-083709 IL Primary

Addresses

Primary practice location

259 1St St
Mineola, NY 11501-3957

Mailing address

11115 Parkview Plaza Dr
Fort Wayne, IN 46845-1701

Other practice location 1

6151 S Yale Ave Ste 1305
Tulsa, OK 74136-1907
Phone (918) 494-9450

Other practice location 2

11115 Parkview Plaza Dr
Fort Wayne, IN 46845-1701
Phone (260) 266-5400

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address lglynn421579@nyumc.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, MO, NY3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20031212000758 IL Practitioner - General SurgeryPractitioner - General PracticePractitioner - Pediatric Medicine 6103723747 Reassigns benefits to 1 organization
I20200415002617 MO Practitioner - General Surgery 6103723747 Reassigns benefits to 2 organizations
I20201218002511 NY Practitioner - Pediatric Medicine 6103723747 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-083709ILMDPediatric Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rockford Health Physicians CurrentSince Mar 19, 2018 Accepting new patients
New York University CurrentSince Jan 1, 2021 Accepting new patients
New York University CurrentSince Jan 1, 2021 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Apr 13, 2020 Accepting new patients
NYU Langone Hospitals Past Accepting new patients
Arkansas Childrens Hospital Past Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

29624 Network Pl
Chicago, IL 60673
Phone (608) 741-7652

2300 N Rockton Ave
Rockford, IL 61103
Phone (815) 971-5510

2350 N Rockton Ave
Rockford, IL 61103
Phone (815) 971-2200

2400 N Rockton Ave
Rockford, IL 61103
Phone (815) 971-6310

448 State Highway 248
Ste 150
Branson, MO 65616
Phone (417) 336-6713

259 1st St
Mineola, NY 11501
Phone (516) 576-1820

13303 Jamaica Ave
Richmond Hill, NY 11418
Phone (718) 206-6942

13303 Jamaica Ave
#13292
Richmond Hill, NY 11418
Phone (718) 291-3276

14 Wall St
Fl 9
Wall Street, NY 10005
Phone (646) 501-3224

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1132099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619568000000",
    "number": "1235111014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11115 PARKVIEW PLAZA DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "259 1ST ST",
            "city": "MINEOLA",
            "state": "NY",
            "postal_code": "115013957",
            "telephone_number": "516-663-4600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6151 S Yale Ave Ste 1305",
            "address_purpose": "LOCATION",
            "city": "Tulsa",
            "state": "OK",
            "postal_code": "741361907",
            "country_code": "US",
            "telephone_number": "918-494-9450",
            "fax_number": "918-494-9437",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11115 Parkview Plaza Dr",
            "address_purpose": "LOCATION",
            "city": "Fort Wayne",
            "state": "IN",
            "postal_code": "468451701",
            "country_code": "US",
            "telephone_number": "260-266-5400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GLYNN",
        "first_name": "LORETTO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-16",
        "last_updated": "2021-04-28",
        "certification_date": "2021-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0120X",
            "taxonomy_group": "",
            "desc": "Surgery, Pediatric Surgery",
            "state": "OK",
            "license": "35914",
            "primary": false
        },
        {
            "code": "2086S0120X",
            "taxonomy_group": "",
            "desc": "Surgery, Pediatric Surgery",
            "state": "IL",
            "license": "036-083709",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lglynn421579@nyumc.direct-ci.com",
            "affiliation": "N",
            "address_1": "259 1st St",
            "city": "Mineola",
            "state": "NY",
            "country_code": "US",
            "postal_code": "115013957",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mineola, NY

Sources for this page

Verify at the official NPI Registry.