Glenn D Babus, DO
Individual provider Active NPI Pain Medicine (Anesthesiology) Physician · Staten Island, NY
NPI 1700867413 · NPPES record last updated Jan 9, 2019
Key facts
- NPI
- 1700867413
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pain Medicine (Anesthesiology) Physician 207LP2900X
- License
- 228217-1 (NY)
- Practice address
- 1099 Targee St
Staten Island, NY 10304 - Phone
- (718) 448-3210
- Fax
- (718) 984-2642
- NPI assigned
- Nov 9, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 8
Medicare Care Compare profile
Merit-based Incentive Payment System (MIPS)
- Final score
- 93.07 of 100
- Quality
- 79.77
- Promoting interoperability
- 88.77
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in NY, TX, TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040510000494 | NY | Practitioner - Interventional Pain Management | 8022007640 | Reassigns benefits to 1 organization |
| I20040614001428 | TX | Practitioner - Pain Management |
8022007640 | Reassigns benefits to 1 organization |
| I20200511002042 | TN | Practitioner - Pain Management |
8022007640 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| H0073176 | MD | MD | Pain Medicine (Anesthesiology) Physician |
| 25MB09495900 | NJ | MD | Pain Medicine (Anesthesiology) Physician |
| 228217-1 | NY | MD | Pain Medicine (Anesthesiology) Physician |
| DO0000002111 | TN | MD | Pain Medicine (Anesthesiology) Physician |
| 0102201908 | VA | MD | Pain Medicine (Anesthesiology) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| David R Jones M.D.,P.a. | Pain Medicine | Current |
Accepting new patients |
| Vascura Pain & Vein PA | Pain Medicine | Current | Accepting new patients |
| David R Jones M.D.,P.a. | Current |
Accepting new patients | |
| 45 Urgent Care, P.C. | Current |
Accepting new patients | |
| True North Medical Group PC | Current |
Accepting new patients | |
| True North Medical Group PC | Current |
Accepting new patients | |
| A Life Without Pain NJ PC | Pain Medicine | Current | Accepting new patients |
| A Life Without Pain LLC | Pain Medicine | Current | Accepting new patients |
Locations
36 Lincoln Ave
Fl 3
Rockville Ctr, NY 11570
1099 Targee St
Staten Island, NY 10304
3333 Hylan Blvd
Staten Island, NY 10306
Phone (718) 667-3333
3311 Hylan Blvd
Staten Island, NY 10306
Phone (718) 351-3111
149 N Star Dr
Jackson, TN 38305
Phone (731) 499-8634
3070 College St
Ste 406
Beaumont, TX 77701
Phone (409) 434-4735
6901 Medical Center Dr
Ste 230
Orange, TX 77630
Phone (409) 883-5300
610 Strickland Dr
Ste 320
Orange, TX 77630
Phone (409) 670-0700
Interoperability endpoints
- glennbabus@nslijmedgr.allscriptsdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pain Medicine (Anesthesiology) Physician | 207LP2900X | J0434 | TX | |
| Pain Medicine (Anesthesiology) Physician | 207LP2900X | H0073176 | MD | |
| Pain Medicine (Anesthesiology) Physician | 207LP2900X | 0102201908 | VA | |
| Pain Medicine (Anesthesiology) Physician | 207LP2900X | DO0000002111 | TN | |
| Pain Medicine (Anesthesiology) Physician | 207LP2900X | 25MB09495900 | NJ | |
| Pain Medicine (Anesthesiology) Physician | 207LP2900X | 228217-1 | NY | Yes |
Addresses
Primary practice location
1099 Targee St
Staten Island, NY 10304
Mailing address
2535 Arthur Kill Rd
Staten Island, NY 10309-1207
Phone (718) 448-3210
Other practice location 1
3311 Hylan Blvd
Staten Island, NY 10306-3611
Phone (718) 448-3210
Other providers in Staten Island, NY
- Irina Baboshkina
- Archana Babu
- Arun N Babu
- Lakshmi Arun Babu
- Shari Babu
- Babymedevac, Inc.
- Rochelle Kaye Bacayana
- Ira Bace
- John F Bachi
- Back to Health Chiropractic, P.C
All providers in Staten Island, NY · Pain Medicine (Anesthesiology) Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 9, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.