Individual provider Active NPI

Milan Glumicic

  • Internal Medicine Physician
  • Jackson Heights, NY
National Provider Identifier
1750671160
Registry record updated Dec 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
289049 Issued in NY
Practice address
3515 78TH St
Jackson Heights, NY 11372-4740
Phone
(718) 478-3523
NPI assigned
Apr 19, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2017

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 0289049 NY
Student in an Organized Health Care Education/Training Program 390200000X
Internal Medicine Physician 207R00000X 289049 NY Primary

Addresses

Primary practice location

3515 78TH St
Jackson Heights, NY 11372-4740

Mailing address

3515 78TH St
Jackson Heights, NY 11372-4740
Phone (718) 478-3523

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, TX2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20171002002872 NY Practitioner - Internal Medicine 4385919349 Reassigns benefits to 2 organizations
I20220131000234 TX Practitioner - Internal Medicine 4385919349 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0289049NYMDInternal Medicine Physician
289049NYMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Our Lady of Lourdes Memorial Hospital, Inc. CurrentSince Aug 22, 2017 Accepting new patients
Great Lakes Physician Practice PC Internal Medicine CurrentSince Jun 10, 2023 Accepting new patients
Yellowhawk Tribal Health Center CurrentSince Jan 1, 2022 Accepting new patients
Jamestown Area Medical Associates, L.L.P. Internal Medicine CurrentSince Jun 1, 1997 Accepting new patients
Our Lady of Lourdes Memorial Hospital Inc. CurrentSince Aug 22, 2017 Accepting new patients

Locations

169 Riverside Dr
Binghamton, NY 13905
Phone (607) 798-5111

276-280 Robinson St
Binghamton, NY 13904
Phone (607) 722-2769

169 Riverside Dr
Ste 206
Binghamton, NY 13905
Phone (607) 798-6701

15 S Main St
Ste 150
Jamestown, NY 14701
Phone (716) 483-6700

31 Sherman St
Ste 2400
Jamestown, NY 14701
Phone (814) 483-5306

46314 Timine Way
Pendleton, OR 97801
Phone (541) 966-9830

2 Hot Metal St
Bldg 3RD
Pittsburgh, PA 15203

Interoperability endpoints

  • Direct secure messaging: mglumicic1@hiemail.healtheconnections.org

Organizations & group practices 5

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1303171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1512518400000",
    "number": "1750671160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3515 78TH ST",
            "city": "JACKSON HEIGHTS",
            "state": "NY",
            "postal_code": "113724740",
            "telephone_number": "718-478-3523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3515 78TH ST",
            "city": "JACKSON HEIGHTS",
            "state": "NY",
            "postal_code": "113724740",
            "telephone_number": "718-478-3523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLUMICIC",
        "first_name": "MILAN",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-19",
        "last_updated": "2017-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "0289049",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NY",
            "license": "289049",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson Heights, NY

Sources for this page

Verify at the official NPI Registry.