NPIMap

Individual provider Active NPI

Brian Glass, FNP

  • Family Nurse Practitioner
  • Crescent City, CA
National Provider Identifier
1396176202
Registry record updated Apr 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
NP95005781 Issued in CA
Practice address
515 E Washington Blvd
Crescent City, CA 95531-8342
Phone
(707) 460-1802
NPI assigned
Dec 2, 2013
Last updated
Apr 3, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X NP95005781 CA Primary

Addresses

Primary practice location

515 E Washington Blvd
Crescent City, CA 95531-8342

Mailing address

515 E Washington Blvd
Crescent City, CA 95531-8342
Phone (707) 460-1802

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, WV2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20171023001942 CA Practitioner - Nurse Practitioner 4486920279 Reassigns benefits to 2 organizations
I20250501000430 WV Practitioner - Nurse Practitioner 4486920279 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Freedom Medical Care, PLLCGroup PAC ID 3476975368, 2 clinicians
Stallant Medical Group IncGroup PAC ID 6406283845, shared by 2 NPIs, 17 clinicians

Practice addresses (Care Compare)

2308 Curtis Ave
Saint Albans, WV 25177-3260
Phone (304) 400-7241

515 E Washington Blvd
Crescent City, CA 95531-8342
Phone (707) 460-1802

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
NP95005781CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Stallant Medical Group Inc CurrentSince Nov 15, 2025 Accepting new patients
Freedom Medical Care, PLLC Family CurrentSince Feb 7, 2025 Accepting new patients
Stallant Medical Group Inc CurrentSince Nov 15, 2025 Accepting new patients
Uptown Providers Inc PastSince Nov 1, 2020 Accepting new patients

Locations

515 E Washington Blvd
Crescent City, CA 95531
Phone (707) 460-1802

Interoperability endpoints

  • Direct secure messaging: brian.glass.1@33456.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/20531/brand/1/csg/1/fhir/r4

Organizations & group practices 5

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.

Hospital & facility affiliations 8

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": "1385942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775174400000",
    "number": "1396176202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 E WASHINGTON BLVD",
            "city": "CRESCENT CITY",
            "state": "CA",
            "postal_code": "955318342",
            "telephone_number": "707-460-1802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 E WASHINGTON BLVD",
            "city": "CRESCENT CITY",
            "state": "CA",
            "postal_code": "955318342",
            "telephone_number": "707-460-1802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLASS",
        "first_name": "BRIAN",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-12-02",
        "last_updated": "2026-04-03",
        "certification_date": "2026-04-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "NP95005781",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crescent City, CA

Sources for this page

Verify at the official NPI Registry.