Glennise Daneen Pratt, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA21581 Issued in CA

Practice address

36320 Inland Valley Drive
307
Wildomar, CA 92595-9083

Phone

(951) 600-0110

Fax

(951) 600-1489

NPI assigned

Jun 5, 2011

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: glennisepratt@vucdbaiuc.allscriptsdirect.net

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.

• Inland Urgent Care a Medical Corporation

  • Urgent Care Clinic/Center
  • Corona, CA
  • NPI 1013369321
  NPD
• Vitality Urgent Care a Medical Corporation

  • Urgent Care Clinic/Center
  • Temecula, CA
  • NPI 1649052218
  NPD

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

{
    "created_epoch": "1307232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455148800000",
    "number": "1447544630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36320 INLAND VALLEY DR",
            "address_2": "307",
            "city": "WILDOMAR",
            "state": "CA",
            "postal_code": "925957512",
            "telephone_number": "951-600-0110",
            "fax_number": "951-600-1489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36320 INLAND VALLEY DRIVE",
            "address_2": "307",
            "city": "WILDOMAR",
            "state": "CA",
            "postal_code": "925959083",
            "telephone_number": "951-600-0110",
            "fax_number": "951-600-1489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRATT",
        "first_name": "GLENNISE",
        "middle_name": "DANEEN",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-06-05",
        "last_updated": "2016-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA21581",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Denisa Pirvu, NP
• Favian Pliego Castaneda
• Alexander William Pollock
• Cynthia Pouchie
• Korbyn Wesley Pounds
• Jada Prevost
• Jordyn Price
• Ptmx2 LLC
• Purnima K Patel M.D Inc
• Annie Qi

• Physician Assistant in Wildomar, CA
• Providers in Wildomar, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2016; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.