Active NPI
Jorell Glass
- Prosthetics Case Management
- Peoria, IL
National Provider Identifier
1508421579
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthetics Case Management
- Practice address
- 456 Fulton St Ste 180
Peoria, IL 61602-1292 - Phone
- (309) 408-9399
- NPI assigned
- May 6, 2019
- Last updated
- May 6, 2019
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Prosthetics Case Management | 1744P3200X | NU | Primary |
Addresses
Primary practice location
456 Fulton St Ste 180
Peoria, IL 61602-1292
Mailing address
1321 W Maywood Ave
Peoria, IL 61604-2548
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1744P3200X | Other | IL | CERTIFIED HAIR LOSS SPECIALIST |
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)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1557100800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1557100800000",
"number": "1508421579",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1321 W MAYWOOD AVE",
"city": "PEORIA",
"state": "IL",
"postal_code": "616042548"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "456 FULTON ST STE 180",
"city": "PEORIA",
"state": "IL",
"postal_code": "616021292",
"telephone_number": "309-408-9399"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GLASS",
"first_name": "JORELL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-05-06",
"last_updated": "2019-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "1744P3200X",
"taxonomy_group": "",
"desc": "Specialist, Prosthetics Case Management",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CERTIFIED HAIR LOSS SPECIALIST",
"identifier": "1744P3200X",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Peoria, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.