Glenn J Waldt, DO

Primary specialty

Neuromusculoskeletal Medicine & OMM PhysicianTaxonomy code 204D00000X

License

A045921 Issued in NM

Practice address

2803 Doral CT
Las Cruces, NM 88011-8616

Phone

(046) 984-4063

Fax

(877) 532-2113

NPI assigned

Dec 11, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NM

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Pain Management

Education

Philadelphia College of Osteopathic Medicine, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Memorial Medical Center Hospital, Las Cruces, NM, CCN 320018
• Three Crosses Regional Hospital LLC Hospital, Las Cruces, NM, CCN 320091

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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 and National Provider Directory roles.

• Back and Neck Medical Care Center, LLC

  • Medical Specialty Clinic/Center
  • Las Cruces, NM
  • NPI 1417530304

  Neuromusculoskeletal Medicine & Omm

  Medicare reassignment NPD Authorized official
• Limerick Medical Center, PC

  • General Practice Physician
  • Sanatoga, PA
  • NPI 1679945414
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• PHC-Las Cruces Inc

  • General Acute Care Hospital
  • Las Cruces, NM
  • NPI 1700821808
  Care Compare affiliation
• Three Crosses Regional Hospital LLC

  • General Acute Care Hospital
  • Las Cruces, NM
  • NPI 1760020044
  Care Compare affiliation

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715126400000",
    "number": "1437219698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1180 COMMERCE DRIVE #14222",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880118255",
            "telephone_number": "505-695-1227",
            "fax_number": "877-532-2113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2803 DORAL CT",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880118616",
            "telephone_number": "046-984-4063",
            "fax_number": "877-532-2113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALDT",
        "first_name": "GLENN",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-11",
        "last_updated": "2024-05-08",
        "certification_date": "2024-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204D00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "NM",
            "license": "A045921",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "27552381",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wal-Mart Stores East LP
• Wal-Mart Stores East, LP
• Wal-Mart Stores East, LP.
• Wal-Mart Stores, Inc.
• Nancy Ann Walczak
• Walgreen Co
• Walgreen Co
• Walgreen Co
• Walgreen Co
• Walgreen Co

• Neuromusculoskeletal Medicine & OMM Physician in Las Cruces, NM
• Providers in Las Cruces, NM by specialty
• Neuromusculoskeletal Medicine & OMM Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.