Glen Ruel Hayward, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95017322 Issued in CA

Practice address

1441 Liberty St
Redding, CA 96001-0811

Phone

(530) 224-2700

Fax

(530) 224-2738

NPI assigned

May 25, 2021

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 1

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Redding Rancheria

  • Federally Qualified Health Center (FQHC)
  • Weaverville, CA
  • NPI 1386164580

  Corporate Director, Operational/Managerial Control

  CMS ownership
• Redding Rancheria

  • Federally Qualified Health Center (FQHC)
  • Redding, CA
  • NPI 1780423244

  Corporate Director, Operational/Managerial Control

  CMS ownership

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.

• Redding Rancheria

  • Federally Qualified Health Center (FQHC)
  • Redding, CA
  • NPI 1104859354

  CA

  Medicare reassignment NPD
• Redding Rancheria

  • Federally Qualified Health Center (FQHC)
  • Weaverville, CA
  • NPI 1386164580
  NPD
• Redding Rancheria

  • Federally Qualified Health Center (FQHC)
  • Redding, CA
  • NPI 1780423244
  NPD

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

{
    "created_epoch": "1621900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621900800000",
    "number": "1417522145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1441 LIBERTY ST",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960010811",
            "telephone_number": "530-224-2700",
            "fax_number": "530-224-2738"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1441 LIBERTY ST",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960010811",
            "telephone_number": "530-224-2700",
            "fax_number": "530-224-2738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAYWARD",
        "first_name": "GLEN",
        "middle_name": "RUEL",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-05-25",
        "last_updated": "2021-05-25",
        "certification_date": "2021-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95017322",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NP",
            "identifier": "95017322",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mitchell Lynn Hawley, DPM
• Shari Hayden
• Joy Anne Hayes, LCSW
• Lloyd Robert Haynie, RPH
• Tasheda J Hayselden, MD, PSYD
• Mark Harold James Hayward
• Aleen Hazelip, RN
• Stachia Leta Hazlet
• Zi Yang He, PHARM.D
• Stacey Lee Head

• All providers in Redding, CA
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.