Individual provider Active NPI

Sean Glennon

  • Certified Registered Nurse Anesthetist
  • Miami, FL
National Provider Identifier
1619700242
Registry record updated Jun 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
1157049 Issued in TX
Practice address
11200 SW 8TH St
Miami, FL 33199-2516
Phone
(305) 348-5323
NPI assigned
Aug 20, 2024
Last updated
Jun 13, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 1157049 TX Primary
Student in an Organized Health Care Education/Training Program 390200000X NU

Addresses

Primary practice location

11200 SW 8TH St
Miami, FL 33199-2516

Mailing address

11200 SW 8TH St
Miami, FL 33199-2516

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250307000451 TX Practitioner - Certified Registered Nurse Anesthetist (Crna) 6507387453 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wichita Falls Anesthesia PLLCGroup PAC ID 7012259260, 34 clinicians

Practice addresses (Care Compare)

1600 11TH St
Wichita Falls, TX 76301-4300
Phone (940) 764-7000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
United Regional Health Care System Inc Current Accepting new patients
Wichita Falls Anesthesia PLLC CurrentSince Jan 3, 2025 Accepting new patients

Locations

1600 11th St
Wichita Falls, TX 76301
Phone (940) 263-3000

Interoperability endpoints

  • FHIR API: https://epicproxy.et1096.epichosted.com/FHIRProxy/api/FHIR/DSTU2/
  • FHIR API: https://epicproxy.et1096.epichosted.com/FHIRProxy/api/fhir/r4/
  • Direct secure messaging: sglennon79663@unitedregional.medalliesdirect.net

Organizations & group practices 2

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 1

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": "1724112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749772800000",
    "number": "1619700242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11200 SW 8TH ST",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331992516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11200 SW 8TH ST",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331992516",
            "telephone_number": "305-348-5323"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLENNON",
        "first_name": "SEAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-08-20",
        "last_updated": "2025-06-13",
        "certification_date": "2025-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": "1157049",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Miami, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.