NPIMap

Individual provider Active NPI

Myron Lynn Glick, MD

  • Family Medicine Physician
  • Buffalo, NY
National Provider Identifier
1730256942
Registry record updated Oct 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
202577 Issued in NY
Practice address
184 Barton St
Buffalo, NY 14213-1573
Phone
(716) 881-6191
Fax
(716) 881-6247
NPI assigned
Nov 30, 2006
Last updated
Oct 28, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 202577 NY Primary

Addresses

Primary practice location

184 Barton St
Buffalo, NY 14213-1573

Mailing address

184 Barton St
Buffalo, NY 14213-1573
Phone (716) 881-6191

Other identifiers 2

IdentifierTypeStateIssuer
J400194611OtherNYMEDICARE
01706312MedicaidNY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090209000005 NY Practitioner - Family Practice 1153353818 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
State University of New York at Buffalo School of Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jericho Road Ministries, Inc.Group PAC ID 5597992933, 33 clinicians

Practice addresses (Care Compare)

184 Barton St
Buffalo, NY 14213-1573
Phone (716) 348-3000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
202577NYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jericho Road Ministries, Inc. CurrentSince Sep 4, 2013 Accepting new patients
Jericho Road Ministries Inc. CurrentSince Sep 4, 2013 Accepting new patients
Jericho Road Ministries Inc. Past Accepting new patients
Kaleida Health Past Accepting new patients
Elder Medical Services PC PastSince Aug 1, 2004 Accepting new patients

Locations

1021 Broadway St
Buffalo, NY 14212
Phone (716) 529-3020

184 Barton St
Buffalo, NY 14213
Phone (716) 348-3000

Interoperability endpoints

  • Direct secure messaging: myron.glick@jrchc.medentdirect.com

Ownership & related parties

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Jericho Road Community Health CenterBuffalo, NY, CCN 331089 Federally qualified health center W-2 Managing Employee Jul 1, 2019
Jericho Road Community Health CenterBuffalo, NY, CCN 331090 Federally qualified health center W-2 Managing Employee Oct 4, 2025
Jericho Road Community Health CenterBuffalo, NY, CCN 571129 Federally qualified health center W-2 Managing Employee Jul 1, 2019
Jericho Road Community Health CenterBuffalo, NY, CCN 571817 Federally qualified health center W-2 Managing Employee Oct 4, 2025
Jericho Road Community Health Center Vive ClinicBuffalo, NY, CCN 571918 Federally qualified health center W-2 Managing Employee Sep 13, 2013

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 6

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.

Hospital & facility affiliations 7

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": "1164844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445990400000",
    "number": "1730256942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "184 BARTON ST",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142131573",
            "telephone_number": "716-881-6191",
            "fax_number": "716-881-6247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "184 BARTON ST",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142131573",
            "telephone_number": "716-881-6191",
            "fax_number": "716-881-6247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLICK",
        "first_name": "MYRON",
        "middle_name": "LYNN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-30",
        "last_updated": "2015-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "202577",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "J400194611",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01706312",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Buffalo, NY

Sources for this page

Verify at the official NPI Registry.