Glenn John Macdonald, M D

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

158506 Issued in NY

Practice address

26 Davison Ave
Oceanside, NY 11572-2237

Phone

(516) 764-7319

Fax

(561) 764-0804

NPI assigned

Sep 6, 2006

Last updated

May 23, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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 NY

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

Internal Medicine

Education

Other, 1980

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Active Life Health of Garden City Medical PLLCGroup PAC ID 8224368840, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Active Life Health of Garden City Medical PLLC

  • Physical Medicine & Rehabilitation Physician
  • Garden City, NY
  • NPI 1902451107
  Medicare reassignment Care Compare group NPD
• Active Life Health of Garden City Medical PLLC

  dba Arthritis Knee Pain Centers

  • Durable Medical Equipment & Medical Supplies
  • White Plains, NY
  • NPI 1477175545
  NPD

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

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653264000000",
    "number": "1437252665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26 DAVISON AVE",
            "city": "OCEANSIDE",
            "state": "NY",
            "postal_code": "115722237",
            "telephone_number": "516-764-7319",
            "fax_number": "561-764-0804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26 DAVISON AVE",
            "city": "OCEANSIDE",
            "state": "NY",
            "postal_code": "115722237",
            "telephone_number": "516-764-7319",
            "fax_number": "561-764-0804"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3636 33rd St Ste 306",
            "address_purpose": "LOCATION",
            "city": "Long Island City",
            "state": "NY",
            "postal_code": "111062329",
            "country_code": "US",
            "telephone_number": "844-403-4325",
            "fax_number": "424-625-0010",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MACDONALD",
        "first_name": "GLENN",
        "middle_name": "JOHN",
        "credential": "M D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-06",
        "last_updated": "2022-05-23",
        "certification_date": "2022-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "158506",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "15856",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Caroline M Lugo
• Richard A Lupo Jr.
• Jeanne T Luttrell, CCC, SLP
• Erik Craig Lyons, NP
• Hai-Wen Ma, MD
• Cathy Madden, RN
• Tiffany Rose Magno, CRNA
• Mark Joseph Maguire
• Lisa Mahabir, PHARMD
• Timothy Mailloux, M.D.

• Internal Medicine Physician in Oceanside, NY
• Providers in Oceanside, NY by specialty
• Internal Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2022; 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.