NPIMap

Individual provider Active NPI

Susan Rena Glass, NP

  • Obstetrics & Gynecology Nurse Practitioner
  • Fayetteville, NC
National Provider Identifier
1639219546
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology Nurse PractitionerTaxonomy code 363LX0001X
License
200863 Issued in NC
Practice address
2029 Valleygate Dr
Suite 101
Fayetteville, NC 28304-3688
Phone
(910) 323-2103
Fax
(910) 323-2219
NPI assigned
Feb 8, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Nurse Practitioner 363LX0001X 200863 NC Primary

Addresses

Primary practice location

2029 Valleygate Dr
Suite 101
Fayetteville, NC 28304-3688

Mailing address

2029 Valleygate Dr
Suite 101
Fayetteville, NC 28304-3688
Phone (910) 323-2103

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20100929000364 NC Practitioner - Nurse Practitioner 4688606007 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Duke University School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Uwh of the Carolinas PLLCGroup PAC ID 0042448169, 329 clinicians

Practice addresses (Care Compare)

2029 Valleygate Dr
Suite 101
Fayetteville, NC 28304-3772
Phone (910) 323-2103

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.25 of 100Reported as group
Quality
82.32
Promoting interoperability
100
Improvement activities
40
Cost
78.52

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
640HIMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Uwh of the Carolinas, PLLC CurrentSince Aug 1, 2014 Accepting new patients
Whap, PA Past Accepting new patients

Locations

2029 Valleygate Dr
Ste 101
Fayetteville, NC 28304
Phone (910) 323-2103

1806 S Hawthorne Rd
Winston Salem, NC 27103
Phone (336) 768-3632

Interoperability endpoints

  • Direct secure messaging: susan.glass.1@7773.direct.athenahealth.com

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 and National Provider Directory roles.

Hospital & facility affiliations 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1639219546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2029 VALLEYGATE DR",
            "address_2": "SUITE 101",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043688",
            "telephone_number": "910-323-2103",
            "fax_number": "910-323-2219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2029 VALLEYGATE DR",
            "address_2": "SUITE 101",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043688",
            "telephone_number": "910-323-2103",
            "fax_number": "910-323-2219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLASS",
        "first_name": "SUSAN",
        "middle_name": "RENA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LX0001X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": "NC",
            "license": "200863",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

Verify at the official NPI Registry.