NPIMap

Individual provider Active NPI

Richard Lee Glaze, M.D.

  • Pediatrics Physician
  • Opelika, AL
National Provider Identifier
1427190842
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
26042 Issued in AL
Practice address
2401 Village Professional Drive
Opelika, AL 36801-4702
Phone
(334) 749-8121
Fax
(334) 749-6166
NPI assigned
Feb 13, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 26042 AL Primary

Addresses

Primary practice location

2401 Village Professional Drive
Opelika, AL 36801-4702

Mailing address

2401 Village Professional Drive
Opelika, AL 36801-4702
Phone (334) 749-8121

Other identifiers 5

IdentifierTypeStateIssuer
969760OtherAAP ID
26042OtherALALABAMA MEDICAL LICENSE
26042OtherALALABAMA CONTR SUBST CERT
515-22780OtherALBCBS AL PROV # AUBURN
515-22766OtherALBCBS AL PROV # OPELIKA

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)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
26042ALMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The East Alabama Health Care Authority Past Accepting new patients
Pediatric Clinic LLC Pediatrics Past Accepting new patients
Pediatric Clinic LLC Pediatrics Past Accepting new patients
Pediatric Clinic LLC Pediatrics Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: richardglaze@pcllc.allscriptsdirect.net

Organizations & group practices 4

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": "1171324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1427190842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 VILLAGE PROFESSIONAL DRIVE",
            "city": "OPELIKA",
            "state": "AL",
            "postal_code": "368014702",
            "telephone_number": "334-749-8121",
            "fax_number": "334-749-6166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 VILLAGE PROFESSIONAL DRIVE",
            "city": "OPELIKA",
            "state": "AL",
            "postal_code": "368014702",
            "telephone_number": "334-749-8121",
            "fax_number": "334-749-6166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLAZE",
        "first_name": "RICHARD",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-13",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AL",
            "license": "26042",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AAP ID",
            "identifier": "969760",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALABAMA MEDICAL LICENSE",
            "identifier": "26042",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALABAMA CONTR SUBST CERT",
            "identifier": "26042",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS AL PROV # AUBURN",
            "identifier": "515-22780",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS AL PROV # OPELIKA",
            "identifier": "515-22766",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Opelika, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.