Glenn Berry

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

4288 Issued in OK

Practice address

1921 Stonecipher Blvd
Ada, OK 74820

Phone

(580) 436-3980

Fax

(580) 421-6283

NPI assigned

Oct 13, 2009

Last updated

Jul 9, 2015By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Chickasaw Nation Division of Health Chickasaw Nation Medical CenterGroup PAC ID 8426957523, 243 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Chickasaw Nation Division of Health

  dba Chickasaw Nation Medical Center

  • General Acute Care Hospital
  • Ada, OK
  • NPI 1255364923

  TX

  Medicare reassignment Care Compare group NPD
• Chickasaw Nation Division of Health

  dba Chickasaw Nation Tishomingo Clinic

  • Primary Care Clinic/Center
  • Tishomingo, OK
  • NPI 1649330242
  NPD
• Chickasaw Nation Division of Health Chickasaw Nation Medical Center

  dba Minticha Apila

  • Home Health Agency
  • Ada, OK
  • NPI 1811739071
  NPD

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

{
    "created_epoch": "1255392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1436400000000",
    "number": "1376878108",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1921 STONECIPHER BLVD",
            "city": "ADA",
            "state": "OK",
            "postal_code": "74820",
            "telephone_number": "580-436-3980",
            "fax_number": "580-421-6283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1921 STONECIPHER BLVD",
            "city": "ADA",
            "state": "OK",
            "postal_code": "74820",
            "telephone_number": "580-436-3980",
            "fax_number": "580-421-6283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERRY",
        "first_name": "GLENN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-10-13",
        "last_updated": "2015-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "2009025549",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OK",
            "license": "4288",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca Marie Beninati
• Benita W Erwin LCSW Inc PC
• Raelyn Bennett
• Nicholas J. Bentley, D.O.
• Sally Berger
• Cary Berryman, PHARM.D
• Melissa Bevill
• Maranda Bible
• Wendy Sue Biddle, LPC
• Erin Jean Bigelow, D.M.D.

• Physical Therapist in Ada, OK
• Providers in Ada, OK by specialty
• Physical Therapist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.