Glen Michael Dimick, CMD

Primary specialty

Radiation Oncology PhysicianTaxonomy code 2085R0001X

License

2002093 Issued in IN

Practice address

3734 W Denise Dr
Bloomington, IN 47404-8412

Phone

(773) 206-0331

NPI assigned

Nov 30, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: glen.dimick@va.gov

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

{
    "created_epoch": "1606694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606694400000",
    "number": "1689278640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3734 W DENISE DR",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474048412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3734 W DENISE DR",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474048412",
            "telephone_number": "773-206-0331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIMICK",
        "first_name": "GLEN",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "CMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-11-30",
        "last_updated": "2020-11-30",
        "certification_date": "2020-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "IN",
            "license": "2002093",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Glen.dimick@va.gov",
            "affiliation": "Y",
            "affiliationName": "Richard L. Roudebush VA Medical Center",
            "address_1": "1481 W 10th St",
            "city": "Indianapolis",
            "state": "IN",
            "country_code": "US",
            "postal_code": "462022803",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Diane Menke Pence, LLC
• A'Tyra Nyree Dickens
• Heather A Dickerson, NP
• John Diedrich
• Digestive Diseases Center
• Maria Nikolova Disheva
• Cassandra Nicole Dishman-Kessler, DO
• Erica Divine, CNM
• Samantha Jo Divine, PHARMD
• Abigail L Dixon, RBT

• Radiation Oncology Physician in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Radiation Oncology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.