NPIMap

Individual provider Active NPI

Glenn Ray Harris, MD

  • Family Medicine Physician
  • Laurinburg, NC
National Provider Identifier
1538245394
Registry record updated Jul 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
9300142 Issued in NC
Practice address
700A Progress PL
Laurinburg, NC 28352-5545
Phone
(910) 276-6767
NPI assigned
Oct 27, 2006
Last updated
Jul 15, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 9300142 NC Primary

Addresses

Primary practice location

700A Progress PL
Laurinburg, NC 28352-5545

Mailing address

PO Box 19305
Charlotte, NC 28219-9305

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address gharris306828@CarolinasHealthcareSystem.direct-ci.com Atrium Health
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other ABILITY Network

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20050927001289 NC Practitioner - Family Practice 9931155686 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9300142NCMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hospice of Scotland County, Inc Family Medicine CurrentSince Jul 26, 2024 Accepting new patients
Scotland Regional Health Network Family Medicine CurrentSince Jun 28, 2010 Accepting new patients
Scotland Regional Health Network CurrentSince Jun 28, 2010 Accepting new patients
Scotland Regional Health Network Current Accepting new patients
Harris Family Practice PLLC Family Medicine CurrentSince Jan 9, 2008 Accepting new patients
Hospice of Scotland County, Inc Family Medicine Past Accepting new patients
Carolina Family Clinic PA Family Medicine PastSince Jun 14, 2020 Accepting new patients

Locations

100 N 6th St
Ste 900A
Minneapolis, MN 55403

101 Plaza Rd
Laurinburg, NC 28352
Phone (910) 276-1058

500 Lauchwood Dr
Laurinburg, NC 28352
Phone (856) 848-3227

610 Lauchwood Dr
Laurinburg, NC 28352
Phone (910) 276-7176

700A Progress Pl
Laurinburg, NC 28352
Phone (910) 276-1702

24420 Marlboro St
Wagram, NC 28396
Phone (910) 369-3136

Interoperability endpoints

  • Direct secure messaging: gharris306828@carolinashealthcaresystem.direct-ci.com

Ownership & related parties

All facility ownership & control disclosures 6

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

FacilityTypeRoleSince
Scotland Memorial HospitalLaurinburg, NC, CCN 340008 Hospital Corporate Director Mar 24, 2005
Pembroke Family Practice & Urgent CarePembroke, NC, CCN 343982 Rural health clinic Corporate Director Jan 1, 2017
Maxton Family Practice CenterMaxton, NC, CCN 343987 Rural health clinic Corporate Director Jan 1, 2017
Scotland Urgent Care CenterLaurinburg, NC, CCN 343988 Rural health clinic Corporate Director Mar 29, 2005
Laurinburg Family Practice and Urgent CareLaurinburg, NC, CCN 343467 Rural health clinic Corporate Director Oct 1, 2018
Wagram Family PracticeWagram, NC, CCN 343475 Rural health clinic Corporate Director Jan 1, 2017

Owned or controlled facilities with NPI records 6

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

Organizations & group practices 7

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": "1161907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1538245394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19305",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282199305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700A PROGRESS PL",
            "city": "LAURINBURG",
            "state": "NC",
            "postal_code": "283525545",
            "telephone_number": "910-276-6767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "GLENN",
        "middle_name": "RAY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-27",
        "last_updated": "2024-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "9300142",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gharris306828@CarolinasHealthcareSystem.direct-ci.com",
            "affiliation": "Y",
            "affiliationName": "Atrium Health",
            "address_1": "700A Progress Pl",
            "city": "Laurinburg",
            "state": "NC",
            "country_code": "US",
            "postal_code": "283525545",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "ABILITY Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Laurinburg, NC

Sources for this page

Verify at the official NPI Registry.