Individual provider Active NPI

Tom Gladfelter, MD

  • Family Medicine Physician
  • Melbourne, FL
National Provider Identifier
1508954736
Registry record updated Aug 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME158244 Issued in FL
Practice address
2120 Sarno Rd
Melbourne, FL 32935-3084
Phone
(321) 241-6800
Fax
(321) 241-6890
NPI assigned
Oct 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X ME158244 FL Primary
Family Medicine Physician 207Q00000X 036071703 IL

Addresses

Primary practice location

2120 Sarno Rd
Melbourne, FL 32935-3084

Mailing address

PO Box 1137
Melbourne, FL 32902-1137
Phone (321) 952-9696

Other practice location 1

Chicago Department of Public health
333 S State Street Revenue #200
Chicago, IL 60604
Phone (312) 747-9443

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20230317001605 FL Order and Referring Only - Family PracticePractitioner - Family Practice 8527036961

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME158244FLMDFamily Medicine Physician
036071703ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Board of Trustees of the University of Illinois Past Accepting new patients
The Board of Trustees of the University of Illinois Family Medicine Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: tom.gladfelter@bha.eclinicaldirectplus.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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691020800000",
    "number": "1508954736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1137",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329021137",
            "telephone_number": "321-952-9696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2120 SARNO RD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329353084",
            "telephone_number": "321-241-6800",
            "fax_number": "321-241-6890"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Chicago Department of Public health",
            "address_2": "333 S State Street Revenue #200",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "60604",
            "country_code": "US",
            "telephone_number": "312-747-9443",
            "fax_number": "312-747-9447",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GLADFELTER",
        "first_name": "TOM",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-11",
        "last_updated": "2023-08-03",
        "certification_date": "2023-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME158244",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036071703",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Melbourne, FL

Sources for this page

Verify at the official NPI Registry.