Active NPI
Gary Alan Glicksteen, M.D.
- Internal Medicine Physician
- Jacksonville, FL
National Provider Identifier
1689758211
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- ME74520
- Practice address
- 8614 Baymeadows Way Ste 100
Jacksonville, FL 32256-8236 - Phone
- (904) 396-0450
- Fax
- (904) 346-0212
- NPI assigned
- Oct 24, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | ME74520 | FL | Primary |
Addresses
Primary practice location
8614 Baymeadows Way Ste 100
Jacksonville, FL 32256-8236
Mailing address
8614 Baymeadows Way
Suite 100
Jacksonville, FL 32256-8236
Phone (904) 396-0450
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P01028954 | Other | FL | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME74520 | FL | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Baptist Primary Care Inc | Internal Medicine | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Family Medicine Physician
- Jacksonville, FL
- NPI 1508817529
Internal Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1450051200000",
"number": "1689758211",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8614 BAYMEADOWS WAY",
"address_2": "SUITE 100",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322568236",
"telephone_number": "904-396-0450",
"fax_number": "904-346-0212"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8614 BAYMEADOWS WAY STE 100",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322568236",
"telephone_number": "904-396-0450",
"fax_number": "904-346-0212"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GLICKSTEEN",
"first_name": "GARY",
"middle_name": "ALAN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-24",
"last_updated": "2015-12-14",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "FL",
"license": "ME74520",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P01028954",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.