Glen Allen Halvorson, M.D.

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

13423 Issued in AZ

Practice address

4550 E Bell Rd
Suite 150
Phoenix, AZ 85032-9306

Phone

(602) 795-3649

Fax

(602) 795-3996

NPI assigned

Oct 15, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA, AZ2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Vitality Medical Care LLC

  • Family Medicine Physician
  • Sherman Oaks, CA
  • NPI 1760231716
  Medicare reassignment NPD
• Az Integrated Neuro Spine & Pain LLC

  • Neurology Physician
  • Sun City, AZ
  • NPI 1487155354
  Medicare reassignment

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

{
    "created_epoch": "1160870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487289600000",
    "number": "1588754873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4550 E BELL RD",
            "address_2": "SUITE 150",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850329306",
            "telephone_number": "602-795-3649",
            "fax_number": "602-795-3996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4550 E BELL RD",
            "address_2": "SUITE 150",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850329306",
            "telephone_number": "602-795-3649",
            "fax_number": "602-795-3996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALVORSON",
        "first_name": "GLEN",
        "middle_name": "ALLEN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-15",
        "last_updated": "2017-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "CA",
            "license": "G75477",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "CO",
            "license": "47769",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NV",
            "license": "13342",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "AZ",
            "license": "13423",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AHCCCS",
            "identifier": "235780",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daniel Halter
• Robert C Halter, PHARMD
• Georgiana M Halterman, M.D.
• Stacey Halverson, PH D
• Christopher Halvorsen, PHARMD
• Michele Y Halyard, M.D.
• Alana Ham, LCSW
• Kirsten Lyn Hamacher, MD
• Amal Hamad
• Ignacia M Haman, RBT

• Physical Medicine & Rehabilitation Physician in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Physical Medicine & Rehabilitation Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2017; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.