NPIMap

Individual provider Active NPI

Glenn Crotty Jr., MD

  • Endocrinology, Diabetes & Metabolism Physician
  • Charleston, WV
National Provider Identifier
1528025640
Registry record updated Nov 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
10877 Issued in WV
Practice address
501 Morris St
Charleston, WV 25301-1326
Phone
(304) 388-7647
Fax
(304) 388-7696
NPI assigned
May 1, 2006
Last updated
Nov 20, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 10877 WV Primary

Addresses

Primary practice location

501 Morris St
Charleston, WV 25301-1326

Mailing address

PO Box 1320
Saint Albans, WV 25177-1320
Phone (304) 388-1724

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150416001639 WV Order and Referring Only - EndocrinologyPractitioner - Endocrinology 3274430509

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Camc Plateau Medical Center, Inc. PastSince Dec 22, 2022 Accepting new patients
Camc Greenbrier Valley Medical Center, Inc. PastSince Jan 1, 2023 Accepting new patients

Ownership & related parties

All facility ownership & control disclosures 7

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Vandalia Health Charleston Area Medical CenterCharleston, WV, CCN 510022 Hospital Corporate Director
W-2 Managing Employee		 Mar 28, 2004
Mar 28, 2004
Camc Greenbrier Valley Medical Center IncRonceverte, WV, CCN 510002 Hospital Corporate Director Jan 1, 2023
Camc Greenbrier Valley Medical Center IncRonceverte, WV, CCN 51U002 Hospital Corporate Director Jan 1, 2023
Camc Plateau Medical CenterOak Hill, WV, CCN 51Z317 Hospital Corporate Director
W-2 Managing Employee		 Dec 22, 2022
Dec 22, 2022
Camc Plateau Medical CenterOak Hill, WV, CCN 511317 Hospital Corporate Director
W-2 Managing Employee		 Dec 22, 2022
Dec 22, 2022
Camc Primary Care -SummersvilleSummersville, WV, CCN 513434 Rural health clinic Corporate Director
W-2 Managing Employee		 Mar 28, 2004
Mar 28, 2004
Camc GVMC Primary Care - PeterstownPeterstown, WV, CCN 513438 Rural health clinic Corporate Director
W-2 Managing Employee		 Jan 1, 2023
Jan 1, 2023

Owned or controlled facilities with NPI records 17

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 17

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.

NPI Registry JSON

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

{
    "created_epoch": "1146441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1416441600000",
    "number": "1528025640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1320",
            "city": "SAINT ALBANS",
            "state": "WV",
            "postal_code": "251771320",
            "telephone_number": "304-388-1724",
            "fax_number": "304-388-1721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 MORRIS ST",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253011326",
            "telephone_number": "304-388-7647",
            "fax_number": "304-388-7696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROTTY",
        "first_name": "GLENN",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-01",
        "last_updated": "2014-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "WV",
            "license": "10877",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, WV

Sources for this page

Verify at the official NPI Registry.