Tedmund Glen PO, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

A83322 Issued in CA

Practice address

5549 Van Buren Blvd
Riverside, CA 92503-2068

Phone

(951) 324-5901

Fax

(877) 778-9472

NPI assigned

Oct 25, 2006

Last updated

Apr 16, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

Family Practice

Education

Other, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

North County Health Project IncGroup PAC ID 2769390939, 56 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tpo312976@direct.ochin.org

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.

• North County Health Project Inc

  dba TrueCare

  • Federally Qualified Health Center (FQHC)
  • San Marcos, CA
  • NPI 1245246917
  Medicare reassignment Care Compare group NPD
• Joseph M Molina MD Professional Corporation-Southern California

  • Family Medicine Physician
  • Wilmington, CA
  • NPI 1982976692
  NPD (past)
• Molina Healthcare of California

  • Family Medicine Physician
  • Sacramento, CA
  • NPI 1841305075
  NPD (past)
• North County Health Project Inc

  dba TrueCare

  • Federally Qualified Health Center (FQHC)
  • Ramona, CA
  • NPI 1073529681
  NPD (past)

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429142400000",
    "number": "1518042167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 OCEANGATE",
            "address_2": "SUITE 100",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908024302",
            "telephone_number": "562-499-6191",
            "fax_number": "877-778-9472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5549 VAN BUREN BLVD",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925032068",
            "telephone_number": "951-324-5901",
            "fax_number": "877-778-9472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PO",
        "first_name": "TEDMUND",
        "middle_name": "GLEN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-25",
        "last_updated": "2015-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A83322",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01282953/DU4034",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pleasant Care Corporation (Pleasant Care Riverside)
• Valerie Plesant
• Deonte Plummer
• David Plurad, M.D.
• PNP Estate LLC
• Jaqueline Poblano
• Asia Toyon Polee
• James A. Pollack, M.D.
• Gregory William Pollard, PT
• Christopher Ryan Pollock

• Family Medicine Physician in Riverside, CA
• Providers in Riverside, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.