Individual provider Active NPI

Glenn Mark Gomes, MD

  • Pulmonary Disease Physician
  • Baton Rouge, LA
National Provider Identifier
1558386631
Registry record updated Jun 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
15674 Issued in LA
Practice address
10310 The Grove Blvd
Baton Rouge, LA 70836-6455
Phone
(225) 761-5200
Fax
(225) 761-5711
NPI assigned
Jul 12, 2006
Last updated
Jun 13, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine (Internal Medicine) Physician 207RC0200X 015674 LA
Pulmonary Disease Physician 207RP1001X 15674 LA Primary

Addresses

Primary practice location

10310 The Grove Blvd
Baton Rouge, LA 70836-6455

Mailing address

10310 The Grove Blvd
Baton Rouge, LA 70836-6455
Phone (225) 761-5200

Other identifiers 1

IdentifierTypeStateIssuer
1312037MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
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
I20100922000082 LA Practitioner - Pulmonary DiseasePractitioner - Critical Care (Intensivists) 5496871915 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pulmonary DiseaseAlso: Critical Care (Intensivists)
Education
Louisiana State University School of Medicine in New Orleans, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ochsner Clinic LLCGroup PAC ID 8224933619, 2,845 clinicians

Practice addresses (Care Compare)

10310 The Grove Blvd
Baton Rouge, LA 70836-6455
Phone (225) 761-5200

104 Acadia Park Dr
Raceland, LA 70394-2618
Phone (985) 537-3211

16777 Medical Ctr Dr
Baton Rouge, LA 70816-3254
Phone (225) 754-3278

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
015674LAMDCritical Care Medicine (Internal Medicine) Physician
15674LAMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ochsner Clinic LLC CurrentSince Jun 14, 1993 Accepting new patients
Ochsner Clinic LLC Current Accepting new patients
Ochsner Clinic LLC CurrentSince Jun 14, 1993 Accepting new patients

Locations

10310 The Grove Blvd
Baton Rouge, LA 70836
Phone (225) 761-5239

16777 Medical Center Dr
Baton Rouge, LA 70816
Phone (225) 754-3278

9001 Summa Ave
Baton Rouge, LA 70809

1514 Jefferson Hwy
New Orleans, LA 70121

104 Acadia Park Dr
Raceland, LA 70394
Phone (985) 537-3211

Interoperability endpoints

  • Direct secure messaging: ggomes12107@direct.ochsner.org

Organizations & group practices 3

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560384000000",
    "number": "1558386631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10310 THE GROVE BLVD",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708366455",
            "telephone_number": "225-761-5200",
            "fax_number": "225-761-5711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10310 THE GROVE BLVD",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708366455",
            "telephone_number": "225-761-5200",
            "fax_number": "225-761-5711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOMES",
        "first_name": "GLENN",
        "middle_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-12",
        "last_updated": "2019-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": "LA",
            "license": "015674",
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "LA",
            "license": "15674",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1312037",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baton Rouge, LA

Sources for this page

Verify at the official NPI Registry.