NPIMap

Individual provider Active NPI

Glenn Edward Burnett II, MD

  • Internal Medicine Physician
  • Jackson, WY
National Provider Identifier
1467400747
Registry record updated Jan 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
11577A Issued in WY
Practice address
555 E Broadway Ave Ste 201
Jackson, WY 83001-8640
Phone
(307) 733-7222
Fax
(307) 733-9720
NPI assigned
May 5, 2006
Last updated
Jan 23, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 11577A WY Primary

Addresses

Primary practice location

555 E Broadway Ave Ste 201
Jackson, WY 83001-8640

Mailing address

PO Box 428
Jackson, WY 83001-0428
Phone (307) 733-2722

Other identifiers 1

IdentifierTypeStateIssuer
150006600MedicaidWY

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address gburnett@sjmc.cernerdirect.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180816001505 WY Practitioner - Internal Medicine 1456381680 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Oklahoma College of Medicine, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Teton County Hospital DistrictGroup PAC ID 4880582295, 107 clinicians

Practice addresses (Care Compare)

555 E Broadway Ave
Suite 201
Jackson, WY 83001-8640
Phone (307) 733-7222

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
81.82 of 100Reported as group
Quality
67.1
Promoting interoperability
98
Improvement activities
40
Cost
73.98

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Teton County Hospital District CurrentSince Aug 1, 2018 Accepting new patients
Teton County Hospital District CurrentSince Aug 1, 2018 Accepting new patients
Teton County Hospital District Past Accepting new patients

Organizations & group practices 3

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.

Hospital & facility affiliations 7

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

NPI Registry JSON

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611360000000",
    "number": "1467400747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 428",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830010428",
            "telephone_number": "307-733-2722",
            "fax_number": "307-733-9720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 E BROADWAY AVE STE 201",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830018640",
            "telephone_number": "307-733-7222",
            "fax_number": "307-733-9720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURNETT",
        "first_name": "GLENN",
        "middle_name": "EDWARD",
        "name_suffix": "II",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-05",
        "last_updated": "2021-01-23",
        "certification_date": "2021-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WY",
            "license": "11577A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "150006600",
            "state": "WY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gburnett@sjmc.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "Direct Messaging Address for St John's Health",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Other",
            "address_1": "555 E Broadway Ave Ste 201",
            "city": "Jackson",
            "state": "WY",
            "country_code": "US",
            "postal_code": "830018640",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Jackson, WY

Sources for this page

Verify at the official NPI Registry.