Glenn P. Wedeen, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

G75574 Issued in CA

Practice address

15248 11TH St
Victorville, CA 92395-3704

Phone

(760) 843-6092

NPI assigned

Jun 16, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

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 1

Specialty

Diagnostic Radiology

Education

Chicago College of Medicine and Surgery, 1987

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Desert Advanced Imaging Medical CenterGroup PAC ID 6406749613, 209 clinicians

Fresno Imaging CenterGroup PAC ID 2466553128, 127 clinicians

Beverly Radiology Medical Group IIIGroup PAC ID 3476466376, 327 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations (25 of 43)

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.

• Desert Advanced Imaging Medical Center

  • Diagnostic Radiology Physician
  • Palm Desert, CA
  • NPI 1568416147
  Medicare reassignment Care Compare group NPD
• Fresno Imaging Center

  • Diagnostic Radiology Physician
  • Fresno, CA
  • NPI 1659456499
  Medicare reassignment Care Compare group NPD
• Beverly Radiology Medical Group III

  • Diagnostic Radiology Physician
  • Los Angeles, CA
  • NPI 1962457812
  Medicare reassignment Care Compare group
• Diagnostic Radiological Imaging

  • Diagnostic Radiology Physician
  • Sacramento, CA
  • NPI 1710931910
  Medicare reassignment NPD
• Kern Radiology Medical Group, Inc

  • Diagnostic Radiology Physician
  • Bakersfield, CA
  • NPI 1700821972
  Medicare reassignment NPD
• Modesto Advanced Diagnostic Imaging Medical Center

  dba Modesto Advanced Diag Imaging Medical Center

  • Diagnostic Radiology Physician
  • Modesto, CA
  • NPI 1730133893
  Medicare reassignment NPD
• Norcal Imaging

  • Diagnostic Radiology Physician
  • Concord, CA
  • NPI 1003965997
  Medicare reassignment NPD
• Pronet Imaging Medical Group, Inc.

  • Diagnostic Radiology Physician
  • Los Angeles, CA
  • NPI 1528099488
  Medicare reassignment NPD
• Redlands Family Practice Medical Group Inc.

  dba Optum

  • Family Medicine Physician
  • Redlands, CA
  • NPI 1942482021
  Medicare reassignment NPD
• San Fernando Valley Interventional Radiology and Imaging Center

  • Vascular-Interventional Technology Radiologic Technologist
  • Encino, CA
  • NPI 1942350889
  Medicare reassignment NPD
• Santa Rosa Imaging Medical Center

  • Diagnostic Radiology Physician
  • Santa Rosa, CA
  • NPI 1689890444
  Medicare reassignment NPD
• Stockton Diagnostic Imaging

  • Diagnostic Radiology Physician
  • Stockton, CA
  • NPI 1356538201
  Medicare reassignment NPD

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1265932800000",
    "number": "1275577504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 190",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930620190",
            "telephone_number": "805-522-5940",
            "fax_number": "805-522-6401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15248 11TH ST",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923953704",
            "telephone_number": "760-843-6092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEDEEN",
        "first_name": "GLENN",
        "middle_name": "P.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-16",
        "last_updated": "2010-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "G75574",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G755740",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wave Physical Therapy Inc
• Waves of Life Counseling (Desiree Atwater)
• Paige Weathersby, PHARMD
• Darlene Weaver
• Melvin Webb, M.D.
• Savanah Weems
• Jabree Welch
• Welcome Houses Organization
• Keisha Sue-Ann Wellington
• Denton Hersey Wells, O.D.

• Diagnostic Radiology Physician in Victorville, CA
• Providers in Victorville, CA by specialty
• Diagnostic Radiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2010; 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.

Verify at the official NPI Registry.