Glenn A McDonald, MD

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

J0114 Issued in TX

Practice address

3535 N Fourth St Ste 301
Longview, TX 75605-0037

Phone

(903) 234-9992

Fax

(903) 234-8287

NPI assigned

Apr 20, 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 2

Medicare fee-for-service enrollment

Enrolled in TX, LA2 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

Specialty

Nephrology

Education

University of Texas Medical School at Houston, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Southern Kidney Associates PLLCGroup PAC ID 8325382146, 6 clinicians

East Texas Kidney Specialists,PAGroup PAC ID 6901856806, 10 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• DaVita Longview Dialysis Center Dialysis facility, Longview, TX, CCN 452744
• DaVita Kilgore Dialysis Center Dialysis facility, Kilgore, TX, CCN 452885
• DaVita Broadmoor Dialysis Dialysis facility, Shreveport, LA, CCN 192695
• DaVita Pinecrest Dialysis Center Dialysis facility, Marshall, TX, CCN 452893
• DaVita Henderson Dialysis Center Dialysis facility, Henderson, TX, CCN 452803
• Christus Good Shepherd Medical Center Hospital, Longview, TX, CCN 450032
• Longview Regional Medical Center Hospital, Longview, TX, CCN 450702
• Willis Knighton Medical Center Hospital, Shreveport, LA, CCN 190111
• Christus Shreveport-Bossier Health System Hospital, Shreveport, LA, CCN 190041
• Titus Regional Medical Center Hospital, Mount Pleasant, TX, CCN 450080

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: glenn.mcdonald@direct.davitaphysiciansolutions.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.

• East Texas Kidney Specialists,PA

  • Nephrology Physician
  • Longview, TX
  • NPI 1184689622
  Medicare reassignment Care Compare group NPD
• Southern Kidney Associates PLLC

  • Nephrology Physician
  • Shreveport, LA
  • NPI 1194292516
  Medicare reassignment Care Compare group NPD

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

• Renal Treatment Centers-Southeast, LP.

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Longview, TX
  • NPI 1316900137

  Dialysis facility

  Care Compare affiliation Name & address match
• Renal Treatment Centers-Southeast, LP.

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Marshall, TX
  • NPI 1366406506

  Dialysis facility

  Care Compare affiliation Name & address match
• Christus Good Shepherd Medical Center

  • General Acute Care Hospital
  • Longview, TX
  • NPI 1124092036
  Care Compare affiliation
• Longview Medical Center LP

  • General Acute Care Hospital
  • Longview, TX
  • NPI 1528026267
  Care Compare affiliation
• Titus County Hospital District

  • Multi-Specialty Clinic/Center
  • Mount Pleasant, TX
  • NPI 1063548881

  Hospital

  Care Compare affiliation
• Titus County Hospital District

  • General Acute Care Hospital
  • Mt Pleasant, TX
  • NPI 1174526529
  Care Compare affiliation
• Christus Health Northern Louisiana

  • General Acute Care Hospital
  • Shreveport, LA
  • NPI 1417950106
  Care Compare affiliation
• Willis Knighton Medical Center, Inc.

  • General Acute Care Hospital
  • Bossier City, LA
  • NPI 1003968579
  Care Compare affiliation
• Willis Knighton Medical Center, Inc.

  • General Acute Care Hospital
  • Shreveport, LA
  • NPI 1124170691
  Care Compare affiliation
• Willis Knighton Medical Center, Inc.

  • General Acute Care Hospital
  • Shreveport, LA
  • NPI 1275685539
  Care Compare affiliation
• Willis Knighton Medical Center, Inc.

  • General Acute Care Hospital
  • Shreveport, LA
  • NPI 1568461572
  Care Compare affiliation

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

{
    "created_epoch": "1145491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633478400000",
    "number": "1336104389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3535 N FOURTH ST STE 301",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756050037",
            "telephone_number": "903-234-9992",
            "fax_number": "903-234-8287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 N FOURTH ST STE 301",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756050037",
            "telephone_number": "903-234-9992",
            "fax_number": "903-234-8287"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1815 E 70th St",
            "address_purpose": "LOCATION",
            "city": "Shreveport",
            "state": "LA",
            "postal_code": "711055301",
            "country_code": "US",
            "telephone_number": "800-276-9017",
            "fax_number": "903-234-8287",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCDONALD",
        "first_name": "GLENN",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-20",
        "last_updated": "2021-10-06",
        "certification_date": "2021-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "LA",
            "license": "308302",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "TX",
            "license": "J0114",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMERCIAL",
            "identifier": "752896100",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS & BLUE SHIELD",
            "identifier": "8B0772",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Elaine Marie McDaniel, PTA
• Erika Monique McDaniel, FNP
• Nicholas McDaniel, RBT
• Brittany Ashton McDaniels, FNP-C
• Dustin Max McDermott, M.D.
• John McDonald, DO
• Kassey Marie McDonald, LPC
• Kayln Breanne McDonald, NP
• Meagan Allissa McDonald, RN, MSN, AGNP-C
• McEt-Longview

• Nephrology Physician in Longview, TX
• Providers in Longview, TX by specialty
• Nephrology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2021; 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.