NPIMap

Individual provider Active NPI

Glenmore Hendricks, NP

  • Nurse Practitioner
  • Riverside, CA
National Provider Identifier
1720293277
Registry record updated Apr 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
NP 14239 Issued in CA
Practice address
7117 Brockton Ave
Riverside, CA 92506-2658
Phone
(951) 782-3622
NPI assigned
May 10, 2007
Last updated
Apr 22, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X NP 14239 CA Primary

Addresses

Primary practice location

7117 Brockton Ave
Riverside, CA 92506-2658

Mailing address

12742 Limonite Ave
Eastvale, CA 92880-9630
Phone (951) 782-2731

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, AZ, NC3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20130304000168 CA Practitioner - Nurse Practitioner 4082869789 Reassigns benefits to 1 organization
I20200929002525 AZ Practitioner - Nurse Practitioner 4082869789 Reassigns benefits to 1 organization
I20250423000443 NC Practitioner - Nurse Practitioner 4082869789 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carolinas Medical CenterGroup PAC ID 4789597477, 1,057 clinicians
City of Hope Medical Group of Arizona LLCGroup PAC ID 2264593474, 159 clinicians

Practice addresses (Care Compare)

1021 Morehead Medical Dr
Suite a
Charlotte, NC 28204-2990
Phone (980) 442-2000

1225 Harding PL
Suite 3100
Charlotte, NC 28204-2826
Phone (704) 355-8686

14200 W Celebrate Life Way
Goodyear, AZ 85338-3007
Phone (623) 207-3000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
NP 14239CAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Carolinas Physicians Network Inc CurrentSince Mar 24, 2025 Accepting new patients
Carolinas Medical Center Current Accepting new patients
Careathome Medical Practice Ca PC Nurse Practitioner CurrentSince Sep 1, 2023 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority CurrentSince Mar 24, 2025 Accepting new patients
Carolinas Physicians Network Inc CurrentSince Mar 24, 2025 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority Current Accepting new patients
Carolinas Physicians Network Inc Current Accepting new patients
Carolinas Medical Center Adult Health CurrentSince Mar 24, 2025 Accepting new patients
City of Hope Medical Group of Arizona LLC Nurse Practitioner CurrentSince Apr 13, 2026 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority Current Accepting new patients
Riverside Medical Clinic, Inc Current Accepting new patients
Riverside Medical Clinic, Inc CurrentSince Jan 14, 2013 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority CurrentSince Mar 24, 2025 Accepting new patients
Carolinas Medical Center CurrentSince Mar 24, 2025 Accepting new patients

Locations

14200 W Celebrate Life Way
Goodyear, AZ 85338
Phone (623) 207-3000

600 Anton Blvd
Fl 11
Costa Mesa, CA 92626
Phone (714) 371-4115

12742 Limonite Ave
Eastvale, CA 92880
Phone (951) 739-2746

3660 Arlington Ave
Riverside, CA 92506
Phone (951) 782-3789

6405 Day St
Riverside, CA 92507
Phone (909) 683-6370

1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791

1021 Morehead Medical Dr
Ste A
Charlotte, NC 28204
Phone (704) 355-2884

1225 Harding Pl
Ste 3100
Charlotte, NC 28204
Phone (704) 355-8686

1350 S Kings Dr
Charlotte, NC 28207
Phone (704) 446-1255

14214 Ballantyne Lake Rd
Ste 100
Charlotte, NC 28277
Phone (704) 667-2650

200 Medical Park Dr
Ste 430
Concord, NC 28025
Phone (704) 403-5890

1781 Tate Blvd SE
Ste 203
Hickory, NC 28602
Phone (704) 381-3970

441 McAlister Rd
Lincolnton, NC 28092
Phone (980) 212-4000

441 McAlister Rd
Ste 1200
Lincolnton, NC 28092
Phone (980) 212-6200

Interoperability endpoints

  • Direct secure messaging: ghendricks2990880@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 8

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": "1178755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682121600000",
    "number": "1720293277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12742 LIMONITE AVE",
            "city": "EASTVALE",
            "state": "CA",
            "postal_code": "928809630",
            "telephone_number": "951-782-2731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7117 BROCKTON AVE",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925062658",
            "telephone_number": "951-782-3622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENDRICKS",
        "first_name": "GLENMORE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-10",
        "last_updated": "2023-04-22",
        "certification_date": "2023-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "NP 14239",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

Verify at the official NPI Registry.