Individual provider Active NPI

Daniel Adam Glass, M.D.

  • Otolaryngology Physician
  • Tyler, TX
National Provider Identifier
1487839981
Registry record updated Dec 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
License
P3333 Issued in TX
Practice address
1136 E Grande Blvd
Tyler, TX 75703-3982
Phone
(903) 592-5601
Fax
(903) 595-3304
NPI assigned
Jan 2, 2008
Last updated
Dec 9, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X P3333 TX Primary

Addresses

Primary practice location

1136 E Grande Blvd
Tyler, TX 75703-3982

Mailing address

1136 E Grande Blvd
Tyler, TX 75703-3982
Phone (903) 592-5601

Other identifiers 2

IdentifierTypeStateIssuer
8DG792OtherTXBCBS
305150001MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20120816000580 TX Practitioner - Otolaryngology 0244486744 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Otolaryngology
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Heaton Ear Nose and Throat Associates of East Texas P aGroup PAC ID 4688774482, 7 clinicians

Practice addresses (Care Compare)

1136 E Grande Blvd
Tyler, TX 75703-3982
Phone (903) 592-5601

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.86 of 100Reported as group
Quality
90.06
Promoting interoperability
98
Improvement activities
40
Cost
61.15

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
P3333TXMDOtolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Heaton Ear Nose and Throat Associates of East Texas P a Otolaryngology CurrentSince Jul 1, 2014 Accepting new patients
Fyzical Therapy & Balance Center Tyler PLLC CurrentSince May 1, 2018 Accepting new patients

Locations

1136 E Grande Blvd
Tyler, TX 75703
Phone (903) 592-3666

Interoperability endpoints

  • Direct secure messaging: daniel.glass@1213.chartlogic.direct-ci.com

Organizations & group practices 2

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 2

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": "1199232000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481241600000",
    "number": "1487839981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1136 E GRANDE BLVD",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757033982",
            "telephone_number": "903-592-5601",
            "fax_number": "903-595-3304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1136 E GRANDE BLVD",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757033982",
            "telephone_number": "903-592-5601",
            "fax_number": "903-595-3304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLASS",
        "first_name": "DANIEL",
        "middle_name": "ADAM",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-01-02",
        "last_updated": "2016-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "TX",
            "license": "P3333",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8DG792",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "305150001",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.