Active NPI
Samuel Glick, MD
- Pediatrics Physician
- Los Angeles, CA
National Provider Identifier
1417534009
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- A195032
- Practice address
- 200 UCLA Medical PLZ Ste 265
Los Angeles, CA 90095-8358 - Phone
- (310) 825-0867
- Fax
- (310) 794-5066
- NPI assigned
- Mar 28, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | A195032 | CA | Primary |
Addresses
Primary practice location
200 UCLA Medical PLZ Ste 265
Los Angeles, CA 90095-8358
Mailing address
5767 W Century Blvd Ste 400
Los Angeles, CA 90045-5631
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A195032 | CA | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| UCLA Medical Group | Pediatrics | Past | Accepting new patients |
Interoperability endpoints
- sglick753410@direct.ochin.org
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1616889600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719446400000",
"number": "1417534009",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5767 W CENTURY BLVD STE 400",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900455631"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 UCLA MEDICAL PLZ STE 265",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900958358",
"telephone_number": "310-825-0867",
"fax_number": "310-794-5066"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GLICK",
"first_name": "SAMUEL",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-03-28",
"last_updated": "2024-06-27",
"certification_date": "2024-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "A195032",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.