Individual provider Active NPI

Nicole S Glaser, M.D.

  • Pediatric Endocrinology Physician
  • Sacramento, CA
National Provider Identifier
1447235155
Registry record updated Dec 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Endocrinology PhysicianTaxonomy code 2080P0205X
License
G 77306 Issued in CA
Practice address
2516 Stockton Blvd
Ticon II
Sacramento, CA 95817-2208
Phone
(916) 734-0406
Fax
(916) 734-7070
NPI assigned
Dec 14, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Endocrinology Physician 2080P0205X G 77306 CA Primary

Addresses

Primary practice location

2516 Stockton Blvd
Ticon II
Sacramento, CA 95817-2208

Mailing address

2516 Stockton Blvd
Ticon II
Sacramento, CA 95817-2208
Phone (916) 734-0406

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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

Enrollment IDStateProvider typePAC IDDetails
I20100415000491 CA Practitioner - Pediatric MedicinePractitioner - EndocrinologyPractitioner - Other (Physician) 0840327326 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the Univ of Ca CurrentSince Feb 13, 2010 Accepting new patients
Regents of the Univ of Ca Current Accepting new patients
Regents of the Univ of Ca Pediatric Endocrinology CurrentSince Feb 13, 2010 Accepting new patients
Regents of the Univ of Ca Past Accepting new patients

Locations

4900 Broadway
Ste 2800
Sacramento, CA 95820
Phone (916) 734-9313

2521 Stockton Blvd
Ste 3200
Sacramento, CA 95817
Phone (916) 734-3112

2521 Stockton Blvd
Sacramento, CA 95817
Phone (916) 734-1104

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": "1134518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1322697600000",
    "number": "1447235155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2516 STOCKTON BLVD",
            "address_2": "TICON II",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958172208",
            "telephone_number": "916-734-0406",
            "fax_number": "916-734-7070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2516 STOCKTON BLVD",
            "address_2": "TICON II",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958172208",
            "telephone_number": "916-734-0406",
            "fax_number": "916-734-7070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLASER",
        "first_name": "NICOLE",
        "middle_name": "S",
        "name_prefix": "Ms.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-14",
        "last_updated": "2011-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0205X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Endocrinology",
            "state": "CA",
            "license": "G 77306",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

Verify at the official NPI Registry.