Individual provider Active NPI

Nijole Glaze, M.D.

  • Internal Medicine Physician
  • Lynwood, CA
National Provider Identifier
1356414262
Registry record updated Feb 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A36700 Issued in CA
Practice address
3737 Martin Luther King Jr Blvd Ste 404
Lynwood, CA 90262-3534
Phone
(310) 608-3600
NPI assigned
Nov 16, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 17, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A36700 CA Primary

Addresses

Primary practice location

3737 Martin Luther King Jr Blvd Ste 404
Lynwood, CA 90262-3534

Mailing address

P.O. Box 27206
Los Angeles, CA 90027

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20070801000740 CA Practitioner - General PracticePractitioner - General SurgeryPractitioner - Family Practice 4385735562 Reassigns benefits to 1 organization
Practice locations: Lynwood, CA

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
Other, 1975
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

3737 Martin Luther King Jr Blvd
Suite 404
Lynwood, CA 90262-3534
Phone (310) 608-3600

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
63700CAMDDentist
A36700CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Life Tree Community Health Center, Inc. CurrentSince Jan 2, 2024 Accepting new patients
Arinder Chadha MD Inc. Internal Medicine PastSince Oct 1, 2016 Accepting new patients
Greater Los Angeles Oncology Medical Corporation Past Accepting new patients

Locations

13750 Victory Blvd
Van Nuys, CA 91401
Phone (818) 809-2428

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 3

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.

Hospital & facility affiliations 3

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": "1163635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581897600000",
    "number": "1356414262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 27206",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "90027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3737 MARTIN LUTHER KING JR BLVD STE 404",
            "city": "LYNWOOD",
            "state": "CA",
            "postal_code": "902623534",
            "telephone_number": "310-608-3600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLAZE",
        "first_name": "NIJOLE",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-16",
        "last_updated": "2020-02-17",
        "certification_date": "2020-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A36700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lynwood, CA

Sources for this page

Verify at the official NPI Registry.