Glenn A Davison, DPM

Primary specialty

PodiatristTaxonomy code 213E00000X

License

25MD00196300 Issued in NJ

Practice address

1308 Morris Avenue
Suite 104
Union, NJ 07083-3331

Phone

(908) 688-5577

Fax

(908) 688-2755

NPI assigned

Aug 30, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 8

Medicare fee-for-service enrollment

Enrolled in NJ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

New York College of Podiatric Medicine, 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advanced Podiatry PAGroup PAC ID 7113018185, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Advanced Podiatry PA

  • Podiatrist
  • Union, NJ
  • NPI 1154430411
  Medicare reassignment Care Compare group NPD Authorized official
• United Clinical Group NJ

  • Family Medicine Physician
  • Far Hills, NJ
  • NPI 1831801083
  Medicare reassignment NPD
• The Collaborative Healthcare Group of NJ

  • Internal Medicine Physician
  • North Brunswick, NJ
  • NPI 1275356560

  Podiatrist

  NPD (past)

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196985600000",
    "number": "1285743559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1308 MORRIS AVENUE",
            "address_2": "SUITE 104",
            "city": "UNION",
            "state": "NJ",
            "postal_code": "070833331",
            "telephone_number": "908-688-5577",
            "fax_number": "908-688-2755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1308 MORRIS AVENUE",
            "address_2": "SUITE 104",
            "city": "UNION",
            "state": "NJ",
            "postal_code": "070833331",
            "telephone_number": "908-688-5577",
            "fax_number": "908-688-2755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVISON",
        "first_name": "GLENN",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2007-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NJ",
            "license": "25MD00196300",
            "primary": true
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NY",
            "license": "N0046131",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNOW DMERC",
            "identifier": "3964640001",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "P2215561",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1245201",
            "state": "NJ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NET",
            "identifier": "1K5292",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "6200292",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4532318",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA HEALTH PLANS",
            "identifier": "9350065",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "864965",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kim Ly Dang, RPH
• Angela Davenport, D.C.
• David a. Worth, M.D., P.a.
• David J Jacobs, MD PA
• David S. Wolkstein, M.D. PA
• Sanaz Davoodi, DDS
• Day Star Home Healthcare
• Jesselly De la Cruz, LCSW
• Gian Carlo Ocampo De Lara
• Anthony Patrick De Marco, PSYD

• Podiatrist in Union, NJ
• Providers in Union, NJ by specialty
• Podiatrist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2007; 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.