Tristan David Glenn, DO

Primary specialty

Sports Medicine (Neuromusculoskeletal Medicine) PhysicianTaxonomy code 204C00000X

License

234573 Issued in AK

Practice address

1919 Lathrop St
Fairbanks, AK 99701-5937

Phone

(907) 459-2619

Fax

(907) 374-1089

NPI assigned

Jul 1, 2022

Last updated

Jul 29, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

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 AK

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

Osteopathic Manipulative MedicineAlso: Sports Medicine

Education

University of New England, College of Osteo Medicine, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Tanana Valley Clinic LLCGroup PAC ID 5698056901, 142 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Fairbanks Memorial Hospital Hospital, Fairbanks, AK, CCN 020012

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tristan.glenn.p1@direct.tananavalley.nextgenshare.com

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.

• Tanana Valley Clinic LLC

  • Multi-Specialty Clinic/Center
  • Fairbanks, AK
  • NPI 1922559558
  Medicare reassignment Care Compare group NPD
• Tanana Valley Clinic LLC

  • Multi-Specialty Clinic/Center
  • Fairbanks, AK
  • NPI 1073081485
  NPD

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

• Fairbanks Memorial Hospital, LLC

  • General Acute Care Hospital
  • Fairbanks, AK
  • NPI 1720537178
  Care Compare affiliation

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

{
    "created_epoch": "1656633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753747200000",
    "number": "1437882099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 73720",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997073720",
            "telephone_number": "207-838-2090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1919 LATHROP ST",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997015937",
            "telephone_number": "907-459-2619",
            "fax_number": "907-374-1089"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "315 S Osteopathy Ave",
            "address_purpose": "LOCATION",
            "city": "Kirksville",
            "state": "MO",
            "postal_code": "635016401",
            "country_code": "US",
            "telephone_number": "660-785-1000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GLENN",
        "first_name": "TRISTAN",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-07-01",
        "last_updated": "2025-07-29",
        "certification_date": "2025-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204C00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine, Sports Medicine",
            "state": "AK",
            "license": "234573",
            "primary": true
        },
        {
            "code": "204D00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "AK",
            "license": "234573",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1755983",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeremy Gipson
• Patricia Anne Givens
• Glacier General Medicine, LLC
• Kenneth Douglas Glaeser, MD
• Teresa Ann Glendinning
• Bozena Glover, R.N.
• Christine Gochis, LPN
• Sadie R Goddard
• Jessica Amy Goff, LCSW
• Shawn K Goggins

• Sports Medicine (Neuromusculoskeletal Medicine) Physician in Fairbanks, AK
• Providers in Fairbanks, AK by specialty
• Sports Medicine (Neuromusculoskeletal Medicine) Physician in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2025; 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.