Active NPI
Justin Ball Glover, DO
- Family Medicine Physician
- Philadelphia, PA
National Provider Identifier
1255017331
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- OS026173
- Practice address
- 10800 Knights Rd
Philadelphia, PA 19114-4200 - Phone
- (215) 612-5161
- NPI assigned
- Jun 23, 2023
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | OS026173 | PA | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X | OT022718 | PA |
Addresses
Primary practice location
10800 Knights Rd
Philadelphia, PA 19114-4200
Mailing address
10800 Knights Rd
Philadelphia, PA 19114-4200
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230914002522 | PA | Order and Referring Only - Family Practice | 2860856416 |
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Philadelphia College of Osteopathic Medicine, 2023
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
10800 Knights Rd
Philadelphia, PA 19114-4200
1101 Market St
Philadelphia, PA 19107-2955
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT022718 | PA | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1687478400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1786406400000",
"number": "1255017331",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10800 KNIGHTS RD",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191144200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10800 KNIGHTS RD",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191144200",
"telephone_number": "215-612-5161"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GLOVER",
"first_name": "JUSTIN",
"middle_name": "BALL",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-06-23",
"last_updated": "2026-08-11",
"certification_date": "2026-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "PA",
"license": "OS026173",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "PA",
"license": "OT022718",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2026; 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.
- 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.