Kedric James Glenn, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

S8040 Issued in TX

Practice address

1901 SW H K Dodgen Loop
Temple, TX 76502-1814

Phone

(254) 724-2111

NPI assigned

Mar 19, 2019

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TX

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

Emergency Medicine

Education

Medical College of Wisconsin, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northeast Texas Emergency Physicians PLLCGroup PAC ID 8527420306, 195 clinicians

Mother Frances Hospital Regional Health Care CenterGroup PAC ID 9234025636, 120 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Christus Mother Frances Hospital Hospital, Tyler, TX, CCN 450102

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kglenn483875@direct.sw.org

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.

• Mother Frances Hospital Regional Health Care Center

  • General Acute Care Hospital
  • Tyler, TX
  • NPI 1679578439
  Medicare reassignment Care Compare group NPD
• Northeast Texas Emergency Physicians, PLLC

  • Emergency Medicine Physician
  • Longview, TX
  • NPI 1114607611
  Medicare reassignment Care Compare group NPD
• Century Integrated Partners, Inc

  • Emergency Medicine Physician
  • Dallas, TX
  • NPI 1447615711
  Medicare reassignment NPD
• Christus Trinity Clinic Texas

  • Family Medicine Physician
  • Tyler, TX
  • NPI 1285684225
  Medicare reassignment NPD
• Concord Medical Group of Texas PLLC

  • Emergency Medicine Physician
  • Lubbock, TX
  • NPI 1750790762
  Medicare reassignment NPD
• Concord Medical Group PLLC

  • Emergency Medicine Physician
  • Lubbock, TX
  • NPI 1083630610
  Medicare reassignment NPD
• Mother Frances Hospital Jacksonville

  • Critical Access Hospital
  • Jacksonville, TX
  • NPI 1952306672
  Medicare reassignment NPD
• Christus Trinity Clinic Texas

  • Rural Health Clinic/Center
  • Winnsboro, TX
  • NPI 1801673165
  NPD

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

• Mother Frances Hospital Regional Health Care Center

  • General Acute Care Hospital
  • Tyler, TX
  • NPI 1679578439
  Care Compare affiliation

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

{
    "created_epoch": "1552953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607904000000",
    "number": "1578022398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844658",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752844658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 SW H K DODGEN LOOP",
            "city": "TEMPLE",
            "state": "TX",
            "postal_code": "765021814",
            "telephone_number": "254-724-2111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLENN",
        "first_name": "KEDRIC",
        "middle_name": "JAMES",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-19",
        "last_updated": "2020-12-14",
        "certification_date": "2020-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "S8040",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kglenn483875@direct.sw.org",
            "affiliation": "N",
            "address_1": "1901 SW H K Dodgen Loop",
            "city": "Temple",
            "state": "TX",
            "country_code": "US",
            "postal_code": "765021814",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Dale S. Glass, M.D.
• Eric Allen Glassberg, M. D.
• Marshall Glenister, CRNA
• Andrew Reed Glenn, SLPA
• Jared William Glenn, M.D.
• Rosanne Glinski, PA
• Samantha Glover
• David Frederick Gloyna, M.D.
• April Elizabeth Gneist
• Lisa J. Go, M.D.

• Emergency Medicine Physician in Temple, TX
• Providers in Temple, TX by specialty
• Emergency Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2020; 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.