Individual provider Active NPI

David Glick, M.D.

  • Family Medicine Physician
  • Saint Louis, MO
National Provider Identifier
1679557177
Registry record updated Oct 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
112861 Issued in MO
Practice address
175 N Oaks PLZ
Saint Louis, MO 63121-2925
Phone
(314) 391-9777
Fax
(314) 390-5404
NPI assigned
Nov 30, 2005
Last updated
Oct 21, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 112861 MO Primary

Addresses

Primary practice location

175 N Oaks PLZ
Saint Louis, MO 63121-2925

Mailing address

1395 NW 167TH St
Miami Gardens, FL 33169-5710
Phone (314) 391-9777

Other practice location 1

401 Holly Hills Ave
Saint Louis, MO 63111-2410
Phone (314) 353-5190

Other identifiers 3

IdentifierTypeStateIssuer
204977102MedicaidMO
047010581OtherMOCPIN
20497110MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20110111000302 MO Practitioner - Family PracticePractitioner - Hospice/Palliative Care 8123217866 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Hospice/Palliative Care
Education
Saint Louis University School of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Compass Health IncGroup PAC ID 1951206754, 317 clinicians

Practice addresses (Care Compare)

1780 Old Hwy 50 E
Suite 102
Union, MO 63084-3397
Phone (888) 403-1071

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Compass Health, Inc CurrentSince Mar 6, 2023 Accepting new patients
Compass Health, Inc CurrentSince Mar 6, 2023 Accepting new patients
Ozarks Medical Center Family Medicine Past Accepting new patients

Locations

1800 Community
Clinton, MO 64735
Phone (660) 885-8131

1800 Community
#B
Clinton, MO 64735

102 Compass Point Dr
Saint Charles, MO 63301
Phone (636) 332-8318

3785 New Town Blvd
Saint Charles, MO 63301
Phone (636) 669-2332

8075 Mexico Rd
Saint Peters, MO 63376
Phone (573) 234-5258

101 Progress Pkwy
Sullivan, MO 63080
Phone (573) 468-3555

91 Troy Sq
Troy, MO 63379

1780 Old Highway 50 E
Ste 102
Union, MO 63084
Phone (636) 583-1611

19515 Brune Pkwy
Warrenton, MO 63383
Phone (636) 235-4049

1032 Crosswinds Ct
Wentzville, MO 63385
Phone (636) 332-6000

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1133308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634774400000",
    "number": "1679557177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1395 NW 167TH ST",
            "city": "MIAMI GARDENS",
            "state": "FL",
            "postal_code": "331695710",
            "telephone_number": "314-391-9777",
            "fax_number": "314-390-5404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 N OAKS PLZ",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631212925",
            "telephone_number": "314-391-9777",
            "fax_number": "314-390-5404"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "401 Holly Hills Ave",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631112410",
            "country_code": "US",
            "telephone_number": "314-353-5190",
            "fax_number": "314-353-1310",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GLICK",
        "first_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-30",
        "last_updated": "2021-10-21",
        "certification_date": "2021-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "112861",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "204977102",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CPIN",
            "identifier": "047010581",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20497110",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.