Active NPI
Richard D. Glasow, MD
- Family Medicine Physician
- Shoreview, MN
National Provider Identifier
1487614335
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 30103
- Practice address
- 4194 Lexington Ave N
Shoreview, MN 55126-6106 - Phone
- (651) 483-5461
- Fax
- (651) 483-2155
- NPI assigned
- Mar 24, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 30103 | MN | Primary |
Addresses
Primary practice location
4194 Lexington Ave N
Shoreview, MN 55126-6106
Mailing address
2925 Chicago Ave
Minneapolis, MN 55407-1321
Phone (612) 262-5000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 787088400 | Medicaid | MN |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | rglasow90689@excellian.direct.allina.com | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30103 | MN | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1615420800000",
"number": "1487614335",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2925 CHICAGO AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554071321",
"telephone_number": "612-262-5000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4194 LEXINGTON AVE N",
"city": "SHOREVIEW",
"state": "MN",
"postal_code": "551266106",
"telephone_number": "651-483-5461",
"fax_number": "651-483-2155"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GLASOW",
"first_name": "RICHARD",
"middle_name": "D.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-24",
"last_updated": "2021-03-11",
"certification_date": "2021-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MN",
"license": "30103",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "787088400",
"state": "MN"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "rglasow90689@excellian.direct.allina.com",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "CDA/PDF/TXT",
"address_1": "4194 Lexington Ave N",
"city": "Shoreview",
"state": "MN",
"country_code": "US",
"postal_code": "551266106",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Shoreview, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.