NPIMap

Organization Active NPI

Midwest Emergency Grand Island Inc

  • Emergency Medicine Physician
  • Grand Island, NE
National Provider Identifier
1508357930
Registry record updated May 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
MIDWEST EMERGENCY GRAND ISLAND INC
Practice address
2620 W Faidley Ave
Grand Island, NE 68803-4205
Phone
(308) 384-4600
Fax
(904) 265-8181
NPI assigned
May 22, 2018
Last updated
May 22, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 2018

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

Authorized official

Name
Carmon L Glover, DONPI 1497701510
Title
Owner
Phone
(888) 577-6337

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X NU Primary

Addresses

Primary practice location

2620 W Faidley Ave
Grand Island, NE 68803-4205

Mailing address

PO Box 797023
Saint Louis, MO 63179-7000
Phone (888) 577-6337

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180711000546 NE Part B Supplier - Clinic/Group Practice 1153677828 Receives reassigned benefits from 71 practitioners
Practice locations: Grand Island, NE; Kearney, NE

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 72

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 72

NPI Registry JSON

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

{
    "created_epoch": "1526947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526947200000",
    "number": "1508357930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 797023",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631797000",
            "telephone_number": "888-577-6337",
            "fax_number": "904-265-8181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2620 W FAIDLEY AVE",
            "city": "GRAND ISLAND",
            "state": "NE",
            "postal_code": "688034205",
            "telephone_number": "308-384-4600",
            "fax_number": "904-265-8181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST EMERGENCY GRAND ISLAND INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-22",
        "last_updated": "2018-05-22",
        "status": "A",
        "authorized_official_last_name": "GLOVER",
        "authorized_official_first_name": "CARMON",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "888-577-6337",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Island, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.