NPIMap

Individual provider Active NPI

Glen Guillermo, MD

  • Emergency Medicine Physician
  • Las Vegas, NV
National Provider Identifier
1275673162
Registry record updated Oct 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
10238 Issued in NV
Practice address
1800 W Charleston Blvd
Las Vegas, NV 89102-2329
Phone
(023) 831-9587
NPI assigned
Feb 8, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 10238 NV Primary

Addresses

Primary practice location

1800 W Charleston Blvd
Las Vegas, NV 89102-2329

Mailing address

1800 W Charleston Blvd
Las Vegas, NV 89102-2386
Phone (702) 383-2000

Other identifiers 1

IdentifierTypeStateIssuer
2018842MedicaidNV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090423000542 NV Practitioner - Emergency Medicine 0648328005 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Nevada School of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Medical Center of Southern NevadaGroup PAC ID 7315934429, 388 clinicians

Practice addresses (Care Compare)

1800 W Charleston Blvd
Las Vegas, NV 89102-2329
Phone (702) 383-2000

Hospital & facility affiliations

  • University Medical Center Hospital, Las Vegas, NV, CCN 290007

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
University Medical Center of Southern Nevada CurrentSince Jul 1, 2024 Accepting new patients
Sound Physicians Emergency Medicine of Nevada Bessler PLLC Emergency Medicine CurrentSince Jul 1, 2020 Accepting new patients
University Medical Center of Southern Nevada CurrentSince Jul 1, 2024 Accepting new patients
Terrebonne Parish Hospital Service District #1 Past Accepting new patients

Locations

1800 W Charleston Blvd
Las Vegas, NV 89102
Phone (702) 207-8253

2375 E Prater Way
Sparks, NV 89434
Phone (775) 331-7000

Interoperability endpoints

  • Direct secure messaging: gguillermo9740@direct.umcsn.com

Organizations & group practices 4

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.

Hospital & facility affiliations 12

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730160000000",
    "number": "1275673162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 W CHARLESTON BLVD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891022386",
            "telephone_number": "702-383-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 W CHARLESTON BLVD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891022329",
            "telephone_number": "023-831-9587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUILLERMO",
        "first_name": "GLEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-08",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NV",
            "license": "10238",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2018842",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.