Individual provider Active NPI

Douglas M Glassman, DC

  • Chiropractor
  • Holbrook, NY
National Provider Identifier
1275542565
Registry record updated Feb 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
X006064 Issued in NY
Practice address
233 Union Ave
Suite 102
Holbrook, NY 11741-1820
Phone
(631) 981-2222
Fax
(631) 981-2279
NPI assigned
Aug 5, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 13, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X X006064 NY Primary

Addresses

Primary practice location

233 Union Ave
Suite 102
Holbrook, NY 11741-1820

Mailing address

PO Box 129
Holbrook, NY 11741-0129
Phone (631) 981-2222

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070403000514 NY Practitioner - Chiropractic 3375647118 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
New York Chiropractic College, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Envision Wellness Chiropractic PCGroup PAC ID 7911261201, 2 clinicians

Practice addresses (Care Compare)

1461 Lakeland Ave
Unit 9
Bohemia, NY 11716-2174
Phone (631) 467-8224

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
X006064NYMDChiropractor
006064NYMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Envision Wellness Chiropractic PC CurrentSince Apr 6, 2024 Accepting new patients
Paul M Vassa DC PC Chiropractor PastSince Jun 29, 2017 Accepting new patients

Locations

1461 Lakeland Ave
Unit 9
Bohemia, NY 11716
Phone (631) 467-8224

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1423785600000",
    "number": "1275542565",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 129",
            "city": "HOLBROOK",
            "state": "NY",
            "postal_code": "117410129",
            "telephone_number": "631-981-2222",
            "fax_number": "631-981-2279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "233 UNION AVE",
            "address_2": "SUITE 102",
            "city": "HOLBROOK",
            "state": "NY",
            "postal_code": "117411820",
            "telephone_number": "631-981-2222",
            "fax_number": "631-981-2279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLASSMAN",
        "first_name": "DOUGLAS",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-05",
        "last_updated": "2015-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NY",
            "license": "X006064",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Holbrook, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2015; 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.