NPIMap

Individual provider Active NPI

Glen Rivera, PA-C

  • Physician Assistant
  • Lexington, VA
National Provider Identifier
1316052111
Registry record updated Jan 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0110002571 Issued in VA
Practice address
108 Houston St Ste E
Lexington, VA 24450-2455
Phone
(540) 463-2227
NPI assigned
Aug 20, 2006
Last updated
Jan 26, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0110002571 VA Primary
Medical Physician Assistant 363AM0700X C0006682 MD
Medical Physician Assistant 363AM0700X 102256 NC
Medical Physician Assistant 363AM0700X 0110002571 VA

Addresses

Primary practice location

108 Houston St Ste E
Lexington, VA 24450-2455

Mailing address

108 Houston St Ste E
Lexington, VA 24450-2455
Phone (540) 463-2227

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20080118000481 VA Practitioner - Physician Assistant 8628025830 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carilion Rockbridge Community HospitalGroup PAC ID 4789658261, shared by 10 NPIs, 104 clinicians

Practice addresses (Care Compare)

1 Health Cir
Lexington, VA 24450-2448
Phone (540) 458-3300

108 Houston St
Lexington, VA 24450-2455

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0110002571VAMDPhysician Assistant
C0006682MDMDMedical Physician Assistant
102256NCMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Carilion Medical Center CurrentSince Aug 1, 2022 Accepting new patients
Carilion Rockbridge Community Hospital CurrentSince Aug 1, 2022 Accepting new patients
Valley Physician Enterprise, Inc. CurrentSince Jun 1, 2016 Accepting new patients
Carilion Medical Center CurrentSince Aug 1, 2022 Accepting new patients
Valley Physician Enterprise, Inc. CurrentSince Jun 1, 2016 Accepting new patients
Carilion Rockbridge Community Hospital CurrentSince Aug 1, 2022 Accepting new patients
Carilion Medical Center Past Accepting new patients
Frederick Medical & Pulmonary Assoc Past Accepting new patients
Commonwealth Orthopaedics & Rehabilitation, PC Past Accepting new patients
Carilion Healthcare Corporation Past Accepting new patients
Frederick Health Hospital Inc Past Accepting new patients
Heart & Vascular Institute of Winchester LLC Past Accepting new patients

Locations

1000 N Shenandoah Ave
Front Royal, VA 22630
Phone (540) 636-0300

1 Health Cir
Lexington, VA 24450
Phone (540) 458-3300

108 Houston St
Ste E
Lexington, VA 24450
Phone (540) 463-2227

2017 Jefferson St SW
Roanoke, VA 24014
Phone (540) 981-7128

213 S Jefferson St
Ste 625
Roanoke, VA 24011
Phone (540) 224-5677

Interoperability endpoints

  • Direct secure messaging: grivera153674@direct.carilionclinic.org
  • Direct secure messaging: grivera61534@soc.inova.org
  • FHIR API: https://fhir4.healow.com/fhir/r4/IFDIBA

Organizations & group practices 14

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

View all 14

Hospital & facility affiliations 9

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": "1156032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706227200000",
    "number": "1316052111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 HOUSTON ST STE E",
            "city": "LEXINGTON",
            "state": "VA",
            "postal_code": "244502455",
            "telephone_number": "540-463-2227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 HOUSTON ST STE E",
            "city": "LEXINGTON",
            "state": "VA",
            "postal_code": "244502455",
            "telephone_number": "540-463-2227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIVERA",
        "first_name": "GLEN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-20",
        "last_updated": "2024-01-26",
        "certification_date": "2024-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "VA",
            "license": "0110002571",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MD",
            "license": "C0006682",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "102256",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "VA",
            "license": "0110002571",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lexington, VA

Sources for this page

Verify at the official NPI Registry.