Individual provider Active NPI

Andrea M Glaser, MD

  • Pediatric Gastroenterology Physician
  • Tyler, TX
National Provider Identifier
1659626802
Registry record updated Jun 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X
License
P1647 Issued in TX
Practice address
3593 E Grande Blvd
Tyler, TX 75707-1400
Phone
(903) 539-2585
NPI assigned
Jul 13, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X P1647 TX
Pediatric Gastroenterology Physician 2080P0206X P1647 TX Primary

Addresses

Primary practice location

3593 E Grande Blvd
Tyler, TX 75707-1400

Mailing address

PO Box 846098
Dallas, TX 75284-6098
Phone (903) 324-6400

Other practice location 1

301 University Blvd
Galveston, TX 77555-0351
Phone (409) 772-1596

Other practice location 2

800 E Dawson St
Tyler, TX 75701-2036
Phone (903) 606-7264

Other practice location 3

1120 E Front St
Tyler, TX 75702-8414
Phone (903) 606-3630

Other identifiers 1

IdentifierTypeStateIssuer
P1647OtherTXTX MEDICAL LICENSE NUMBER

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150424000578 TX Practitioner - Pediatric Medicine 4183943194 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
P1647TXMDPediatric Gastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Utmb Faculty Group Practice Pediatrics CurrentSince Apr 2, 2015 Accepting new patients
Christus Trinity Clinic Texas Pediatrics CurrentSince Nov 15, 2021 Accepting new patients
Christus Trinity Clinic Texas CurrentSince Nov 15, 2021 Accepting new patients
Shriners Hospitals for Children CurrentSince Feb 4, 2020 Accepting new patients
Shriners Hospitals for Children CurrentSince Feb 4, 2020 Accepting new patients

Locations

815 Market St
Galveston, TX 77550
Phone (409) 770-6600

301 University Blvd
Galveston, TX 77555
Phone (409) 747-1883

511 Park Grove Dr
Katy, TX 77450
Phone (281) 398-7001

1120 E Front St
Tyler, TX 75702
Phone (903) 597-7902

630 S Fleishel Ave
Tyler, TX 75701
Phone (903) 510-8888

800 E Dawson St
Tyler, TX 75701
Phone (903) 531-5018

3593 E Grande Blvd
Tyler, TX 75707
Phone (903) 606-1664

Interoperability endpoints

  • Direct secure messaging: aglaser260832@christushealth.direct-ci.net

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1342137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719360000000",
    "number": "1659626802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 846098",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752846098",
            "telephone_number": "903-324-6400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3593 E GRANDE BLVD",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757071400",
            "telephone_number": "903-539-2585"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "301 University Blvd",
            "address_purpose": "LOCATION",
            "city": "Galveston",
            "state": "TX",
            "postal_code": "775550351",
            "country_code": "US",
            "telephone_number": "409-772-1596",
            "fax_number": "409-747-4995",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "800 E Dawson St",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "757012036",
            "country_code": "US",
            "telephone_number": "903-606-7264",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1120 E Front St",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "757028414",
            "country_code": "US",
            "telephone_number": "903-606-3630",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GLASER",
        "first_name": "ANDREA",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-13",
        "last_updated": "2024-06-26",
        "certification_date": "2024-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "P1647",
            "primary": false
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "TX",
            "license": "P1647",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TX MEDICAL LICENSE NUMBER",
            "identifier": "P1647",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.