NPIMap

Individual provider Active NPI

Glenn Eric Herrmann, M.D.

  • Plastic and Reconstructive Surgery Physician
  • Lafayette, CO
National Provider Identifier
1629085196
Registry record updated Mar 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
License
44716 Issued in CO
Practice address
130 Old Laramie TRL E BLDG 4
Lafayette, CO 80026-7014
Phone
(303) 664-9400
Fax
(303) 666-5362
NPI assigned
Aug 1, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 29, 2016

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

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Oral & Maxillofacial Surgery (D.M.D.) 204E00000X 44716 CO
Plastic Surgery Physician 208200000X 44716 CO
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician 2082S0099X 44716 CO
Surgery of the Hand (Plastic Surgery) Physician 2082S0105X 44716 CO
Surgery Physician 208600000X 44716 CO
Plastic and Reconstructive Surgery Physician 2086S0122X 44716 CO Primary

Addresses

Primary practice location

130 Old Laramie TRL E BLDG 4
Lafayette, CO 80026-7014

Mailing address

PO Box 767
Lafayette, CO 80026-0767
Phone (303) 664-9400

Other identifiers 1

IdentifierTypeStateIssuer
15035859MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061115000324 CO Practitioner - Plastic and Reconstructive Surgery 2062410608 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Plastic and Reconstructive Surgery
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

130 Old Laramie TRL
Lafayette, CO 80026-7014
Phone (303) 664-9400

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy11
Melanoma (skin cancer) excision15
Removal of tissue727
Removal of skin lesions12
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
44716COMDPlastic and Reconstructive Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Colorado Wound and Ostomy Care, PC CurrentSince Jun 20, 2010 Accepting new patients
Glenn E Herrmann MDPC Plastic Surgery CurrentSince Jul 1, 2008 Accepting new patients
Wound Solutions Inc Plastic and Reconstructive Surgery CurrentSince Jan 1, 2022 Accepting new patients
Coal Creek Ambulatory Surgery Center PC PastSince Jun 5, 2012 Accepting new patients

Locations

1601 Lowell Blvd
Denver, CO 80204
Phone (303) 264-6900

130 Old Laramie Trl
Bldg 4
Lafayette, CO 80026
Phone (303) 664-9400

130 Old Laramie Trl
Lafayette, CO 80026
Phone (303) 664-9400

Organizations & group practices 4

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.

Hospital & facility affiliations 29

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

View all 29

NPI Registry JSON

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459209600000",
    "number": "1629085196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 767",
            "city": "LAFAYETTE",
            "state": "CO",
            "postal_code": "800260767",
            "telephone_number": "303-664-9400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 OLD LARAMIE TRL E BLDG 4",
            "city": "LAFAYETTE",
            "state": "CO",
            "postal_code": "800267014",
            "telephone_number": "303-664-9400",
            "fax_number": "303-666-5362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERRMANN",
        "first_name": "GLENN",
        "middle_name": "ERIC",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2016-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "CO",
            "license": "44716",
            "primary": false
        },
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "CO",
            "license": "44716",
            "primary": false
        },
        {
            "code": "2082S0099X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery, Plastic Surgery Within the Head and Neck",
            "state": "CO",
            "license": "44716",
            "primary": false
        },
        {
            "code": "2082S0105X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery, Surgery of the Hand",
            "state": "CO",
            "license": "44716",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CO",
            "license": "44716",
            "primary": false
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "CO",
            "license": "44716",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "15035859",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lafayette, CO

Sources for this page

Verify at the official NPI Registry.