Active NPI
Glenn A Harris Jr., M.D.
- Specialist
- Fairhope, AL
National Provider Identifier
1659478014
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 200000225
- Practice address
- 150 S Ingleside St Ste 4
Fairhope, AL 36532-1804 - Phone
- (251) 990-1920
- NPI assigned
- Sep 20, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | A68303 | CA | |
| Specialist | 174400000X | 2003029891 | MO | |
| Internal Medicine Physician | 207R00000X | 162439 | NC | |
| Cardiovascular Disease Physician | 207RC0000X | 162439 | NC | |
| Specialist | 174400000X | 200000225 | NC | Primary |
Addresses
Primary practice location
150 S Ingleside St Ste 4
Fairhope, AL 36532-1804
Mailing address
PO Box 448
Waynesville, NC 28786-0448
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5900317 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220329000393 | AL | Practitioner - Cardiovascular Disease (Cardiology) | 3375433758 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Cardiovascular Disease (Cardiology)
- Education
- University of Mississippi School of Medicine, 1992
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
4 Medical Park Dr
Fairhope, AL 36532-2083
Phone (251) 990-1920
Hospital & facility affiliations
- Thomas Hospital
- North Baldwin Infirmary
Merit-based Incentive Payment System (MIPS)
- Final score
- 86.6 of 100
- Quality
- 81.01
- Improvement activities
- 40
- Cost
- 80.65
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Pacemaker insertion or repair | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A68303 | CA | MD | Specialist |
| 2003029891 | MO | MD | Specialist |
| 200000225 | NC | MD | Specialist |
| 162439 | NC | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Heart Group of the Eastern Shore, P.C. | Specialist | Current | Accepting new patients |
| DLP Haywood Regional Medical Center LLC. | Internal Medicine | Past | Accepting new patients |
| Western Carolina Cardiology | Specialist | Past | Accepting new patients |
Locations
4 Medical Park Dr
Fairhope, AL 36532
Phone (251) 990-1920
4 Medical Park
Fairhope, AL 36532
Phone (251) 990-1920
Interoperability endpoints
- glenn.harris.1@27834.direct.athenahealth.com
Organizations & group practices 3
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.
-
- General Acute Care Hospital
- Clyde, NC
- NPI 1811158215
Internal Medicine
-
- Specialist
- Clyde, NC
- NPI 1164466447
Hospital & facility affiliations 4
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": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1647993600000",
"number": "1659478014",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 448",
"city": "WAYNESVILLE",
"state": "NC",
"postal_code": "287860448"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "150 S INGLESIDE ST STE 4",
"city": "FAIRHOPE",
"state": "AL",
"postal_code": "365321804",
"telephone_number": "251-990-1920"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARRIS",
"first_name": "GLENN",
"middle_name": "A",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-20",
"last_updated": "2022-03-23",
"certification_date": "2022-03-23",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "CA",
"license": "A68303",
"primary": false
},
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "MO",
"license": "2003029891",
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "NC",
"license": "162439",
"primary": false
},
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "NC",
"license": "162439",
"primary": false
},
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NC",
"license": "200000225",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5900317",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fairhope, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 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.
- 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.