Glen B Smith, M.D.

Primary specialty

Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X

License

036075454 Issued in IL

Practice address

1505 Eastland Dr
Suite 210
Bloomington, IL 61701-7906

Phone

(309) 662-5506

Fax

(309) 662-5443

NPI assigned

Aug 26, 2005

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 10

Medicare fee-for-service enrollment

Enrolled in IL

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

Thoracic Surgery

Education

Other, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Osf Home Health-Eastern Region Home health agency, Bloomington, IL, CCN 147451
• St Joseph Medical Center Hospital, Bloomington, IL, CCN 140162
• Osf Saint Elizabeth MDL Ctr Hospital, Peru, IL, CCN 140110
• Saint James Hospital Hospital, Pontiac, IL, CCN 140161
• Saint Francis Medical Center Hospital, Peoria, IL, CCN 140067
• Osf Saint Paul Medical Center Hospital, Mendota, IL, CCN 141310

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Osf Multi-Specialty Group

  • Internal Medicine Physician
  • Peoria, IL
  • NPI 1922445527
  Medicare reassignment Care Compare group NPD
• Saint James Hospital

  • Anesthesiology Physician
  • Pontiac, IL
  • NPI 1790735421
  Medicare reassignment
• Illinois Cardiovascular & Thoracic Surgery, LTD

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Bloomington, IL
  • NPI 1962450734
  NPD (past) Authorized official
• Central PA Pharmacy LLC.

  • Community/Retail Pharmacy
  • Patton, PA
  • NPI 1578541413
  NPD
• Gibson Community Hospital Association

  • Critical Access Hospital
  • Gibson City, IL
  • NPI 1114935681
  NPD (past)

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

• Mendota Community Hospital

  • Critical Access Hospital
  • Mendota, IL
  • NPI 1609803113
  Care Compare affiliation
• Ottawa Regional Hospital & Healthcare Center

  • General Acute Care Hospital
  • Peru, IL
  • NPI 1588713440
  Care Compare affiliation
• Saint James Hospital

  • General Acute Care Hospital
  • Pontiac, IL
  • NPI 1407808090
  Care Compare affiliation
• St Joseph Medical Center

  • General Acute Care Hospital
  • Bloomington, IL
  • NPI 1619916806
  Care Compare affiliation
• St Joseph Medical Center

  • Home Health Agency
  • Bloomington, IL
  • NPI 1851330203
  Care Compare affiliation

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

{
    "created_epoch": "1125014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1352764800000",
    "number": "1326031105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1505 EASTLAND DR",
            "address_2": "SUITE 210",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617017906",
            "telephone_number": "309-662-5506",
            "fax_number": "309-662-5443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 EASTLAND DR",
            "address_2": "SUITE 210",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617017906",
            "telephone_number": "309-662-5506",
            "fax_number": "309-662-5443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "GLEN",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-26",
        "last_updated": "2012-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "IL",
            "license": "036075454",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE PROVIDER",
            "identifier": "008131",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "205477201",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHCS",
            "identifier": "37773",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "37893",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "228074",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OSF HEALTH PLANS",
            "identifier": "036075454000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD GROUP NUMBER",
            "identifier": "05732036",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERSONAL CARE",
            "identifier": "233989",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "1955270",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE HEALTH PLAN",
            "identifier": "IL0102",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Grace Mragret Slowikowski
• Smalltown Dental Bloomington on Maloney
• Smart Health & Wellness Center, LLC
• Barbarette Smith, LPC
• Elaine Smith, R.N.
• Jacob Smith, PA-C, ATC
• Jamie Smith, LCSW
• Joshua J Smith, PT
• Katrina Smith
• Maggie Kathleen Smith

• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2012; 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.