Glenn Michael Roschetzky, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

4445 Issued in SC

Practice address

3 Richland Medical Park Dr Ste 310
Columbia, SC 29203-6862

Phone

(803) 434-8323

Fax

(803) 434-8326

NPI assigned

Jun 9, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Broad River Physicians Group, LLC

  • Emergency Medicine Physician
  • Summerville, SC
  • NPI 1295443000
  Medicare reassignment
• Prisma Health Medical Group-Midlands

  • Plastic and Reconstructive Surgery Physician
  • Sumter, SC
  • NPI 1447749510
  NPD
• Prisma Health Medical Group-Midlands

  • Durable Medical Equipment & Medical Supplies
  • Columbia, SC
  • NPI 1881469856
  NPD

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

{
    "created_epoch": "1654732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658448000000",
    "number": "1649909078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MCBEE AVE FL 4",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012842",
            "telephone_number": "864-522-8603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 RICHLAND MEDICAL PARK DR STE 310",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292036862",
            "telephone_number": "803-434-8323",
            "fax_number": "803-434-8326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSCHETZKY",
        "first_name": "GLENN",
        "middle_name": "MICHAEL",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-09",
        "last_updated": "2022-07-22",
        "certification_date": "2022-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "SC",
            "license": "4445",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "4445",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Annette Marie Roper, M.D.
• Julieanne Roper, O.D.
• Elaine Roque Nazario, MD
• Olga Cristina Rosa, MD
• Steven Jay Rosansky, M.D.
• Brandi Nicole Rose, APRN
• Katherine Rose, DMD
• Laura Keys Rose, DPT
• Rachel Rose, PTA
• Ryan Rose, D.M.D

• Physician Assistant in Columbia, SC
• Providers in Columbia, SC by specialty
• Physician Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2022; 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.