Glenn R. Waite, M.D.

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

M-11148 Issued in ID

Practice address

232 S Whisperwood Way
Boise, ID 83709-4900

Phone

(208) 350-6450

Fax

(208) 350-6449

NPI assigned

Aug 2, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 7

Addresses

Other names 1

• Dr. Glenn Ronald Waite Professional name

Medicare fee-for-service enrollment

Enrolled in TX, CO2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: glenn.waite.1@14940.direct.athenahealth.com

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.

• Choctaw Nation of Oklahoma

  • Rural Acute Care Hospital
  • Talihina, OK
  • NPI 1659347623

  TX

  Medicare reassignment NPD
• Wind River Family & Community Healthc Care

  • Federal Public Health Clinic/Center
  • Arapahoe, WY
  • NPI 1285006379

  TX

  Medicare reassignment NPD
• Choctaw Nation of Oklahoma

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Broken Bow, OK
  • NPI 1447143532
  NPD
• Choctaw Nation of Oklahoma

  • Primary Care Clinic/Center
  • McAlester, OK
  • NPI 1952377939
  NPD
• Treasure Valley Neuropathy Relief Center PC

  • Family Medicine Physician
  • Boise, ID
  • NPI 1861827222
  NPD (past)
• HMC Medical Center, LLC

  • Urgent Care Clinic/Center
  • Las Vegas, NV
  • NPI 1194754358
  NPD (past)
• Osteoarthritis Centers of America Medical Group PC

  • Pain Clinic/Center
  • Bluffdale, UT
  • NPI 1376844886
  NPD (past)
• Osteoarthritis Centers of America Medical Group PC

  • Pain Clinic/Center
  • Reno, NV
  • NPI 1508137886
  NPD (past)

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403654400000",
    "number": "1295742948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "232 S WHISPERWOOD WAY",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837094900",
            "telephone_number": "208-350-6450",
            "fax_number": "208-350-6449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "232 S WHISPERWOOD WAY",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837094900",
            "telephone_number": "208-350-6450",
            "fax_number": "208-350-6449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAITE",
        "first_name": "GLENN",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-02",
        "last_updated": "2014-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NV",
            "license": "8577",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A38237",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "23679",
            "primary": false
        },
        {
            "code": "2081P0004X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Spinal Cord Injury Medicine",
            "state": "CA",
            "license": "A38237",
            "primary": false
        },
        {
            "code": "2081P0004X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Spinal Cord Injury Medicine",
            "state": "CO",
            "license": "23679",
            "primary": false
        },
        {
            "code": "2081P0004X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Spinal Cord Injury Medicine",
            "state": "NV",
            "license": "8577",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "ID",
            "license": "M-11148",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GLENN",
            "last_name": "WAITE",
            "middle_name": "RONALD",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Ashlyn Wahl, PA-C
• Travis Wahl
• Jade Anne Wahnschaffe, PHARMD
• Kennedy Kambo Wainaina, PHARM D
• Melissa M. Waine-Cunliffe, OT
• Janice Louise Waite, P.T.
• Katie Diana Waites, PA-C
• Wal-Mart Stores, Inc
• Wal-Mart Stores, Inc
• Laura Elizabeth Walawender, M.D.

• Physical Medicine & Rehabilitation Physician in Boise, ID
• Providers in Boise, ID by specialty
• Physical Medicine & Rehabilitation Physician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2014; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.