Glenn S Hausdorfer, MD

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

G49307 Issued in CA

Practice address

1350 W Covina Blvd
San Dimas, CA 91773-3245

Phone

(909) 599-6811

NPI assigned

Sep 8, 2005

Last updated

Mar 13, 2014By 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

Pathology

Education

University of Southern California Keck School of Medicine, 1981

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Citrus Pathology Medical GroupGroup PAC ID 2668375577, 4 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Emanate Health Inter-Community Hospital Hospital, Covina, CA, CCN 050382
• Glendale Mem Hospital & HLTH Center Hospital, Glendale, CA, CCN 050058

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Citrus Pathology Medical Group

  • Anatomic Pathology & Clinical Pathology Physician
  • Glendale, CA
  • NPI 1265426928
  Medicare reassignment Care Compare group
• Cambridge Labs Inc

  • Clinical Medical Laboratory
  • Reseda, CA
  • NPI 1932345972
  NPD (past)
• Path Labs, LLC

  • Clinical Medical Laboratory
  • Sacramento, CA
  • NPI 1710983671
  NPD (past)
• Neogenomics Laboratories Inc

  dba Pathline

  • Clinical Medical Laboratory
  • Ramsey, NJ
  • NPI 1205063294
  NPD (past)

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

• Dignity Community Care

  dba Glendale Memorial Hospital and Health Center

  • General Acute Care Hospital
  • Glendale, CA
  • NPI 1477610640
  Care Compare affiliation
• Emanate Health Medical Center

  dba Citrus Valley Medical Center Queen Of the Valley Campus

  • General Acute Care Hospital
  • West Covina, CA
  • NPI 1063441293
  Care Compare affiliation
• Emanate Health Medical Center

  dba Emanate Health Inter-Community Hospital

  • Psychiatric Hospital Unit
  • Covina, CA
  • NPI 1215063151
  Care Compare affiliation
• Emanate Health Medical Center

  dba Citrus Valley Medical Center Inter-Community Campus

  • General Acute Care Hospital
  • Covina, CA
  • NPI 1982629440
  Care Compare affiliation

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

{
    "created_epoch": "1126137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1394668800000",
    "number": "1588658249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5700 SOUTHWYCK BLVD",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436141509",
            "telephone_number": "800-288-8325",
            "fax_number": "419-866-5453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 W COVINA BLVD",
            "city": "SAN DIMAS",
            "state": "CA",
            "postal_code": "917733245",
            "telephone_number": "909-599-6811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAUSDORFER",
        "first_name": "GLENN",
        "middle_name": "S",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-08",
        "last_updated": "2014-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "CA",
            "license": "G49307",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G493070",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ian Hansen, M.A. LMFT #121960
• Tanner Calvin Harrah, D.O.
• Sarah Harris, MFT
• Hasmukh G. Joshi, M.D., Inc.
• Zainab Hassanin
• Haven Physical Therapy & Wellness, PC
• Brenda N Hayakawa, MD
• Hannah Micaela Hayes, COTA/L
• Healing Paths Therapy Inc
• Heartfelt Psychiatry

• Anatomic Pathology & Clinical Pathology Physician in San Dimas, CA
• Providers in San Dimas, CA by specialty
• Anatomic Pathology & Clinical Pathology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2014; 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.