Individual provider Active NPI

Anna Marie Glickman, FNP-C

  • Family Nurse Practitioner
  • Casa Grande, AZ
National Provider Identifier
1720605462
Registry record updated Jun 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
242373 Issued in AZ
Practice address
1653 E McMurray Blvd Ste 132
Casa Grande, AZ 85122-5934
Phone
(520) 876-0478
NPI assigned
Jun 29, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 242373 AZ Primary

Addresses

Primary practice location

1653 E McMurray Blvd Ste 132
Casa Grande, AZ 85122-5934

Mailing address

1653 E McMurray Blvd Ste 132
Casa Grande, AZ 85122-5934
Phone (520) 876-0478

Other names 1

  • Anna Marie Ronnerud Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200727003690 AZ Practitioner - Nurse Practitioner 0345664058 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gerald Muthu, LLCGroup PAC ID 2264483718, 2 clinicians

Practice addresses (Care Compare)

1653 E McMurray Blvd
Suite 132
Casa Grande, AZ 85122-5600
Phone (520) 876-0478

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Gerald Muthu, LLC CurrentSince Jul 17, 2020 Accepting new patients

Locations

1653 E McMurray Blvd
Ste 135
Casa Grande, AZ 85122
Phone (520) 876-0478

1653 E McMurray Blvd
Ste 132
Casa Grande, AZ 85122
Phone (520) 876-0478

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 and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1593388800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593388800000",
    "number": "1720605462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1653 E MCMURRAY BLVD STE 132",
            "city": "CASA GRANDE",
            "state": "AZ",
            "postal_code": "851225934",
            "telephone_number": "520-876-0478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1653 E MCMURRAY BLVD STE 132",
            "city": "CASA GRANDE",
            "state": "AZ",
            "postal_code": "851225934",
            "telephone_number": "520-876-0478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLICKMAN",
        "first_name": "ANNA",
        "middle_name": "MARIE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-29",
        "last_updated": "2020-06-29",
        "certification_date": "2020-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "242373",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANNA",
            "last_name": "RONNERUD",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Casa Grande, AZ

Sources for this page

Verify at the official NPI Registry.