Glen A Weisgerber, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036061310 Issued in IL

Practice address

100 S 5TH St
Auburn, IL 62615-1402

Phone

(217) 438-6175

Fax

(217) 438-6550

NPI assigned

Mar 10, 2006

Last updated

Jun 14, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IL

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Glen a Weisgerber MD SC

  • Family Medicine Physician
  • Auburn, IL
  • NPI 1124337605
  NPD Authorized official

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

{
    "created_epoch": "1141948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1276473600000",
    "number": "1760450134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 S 5TH ST",
            "address_2": "PO BOX 227",
            "city": "AUBURN",
            "state": "IL",
            "postal_code": "626141402",
            "telephone_number": "217-438-6175",
            "fax_number": "217-438-6550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 S 5TH ST",
            "city": "AUBURN",
            "state": "IL",
            "postal_code": "626151402",
            "telephone_number": "217-438-6175",
            "fax_number": "217-438-6550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WEISGERBER",
        "first_name": "GLEN",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-10",
        "last_updated": "2010-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036061310",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "14D0435318",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036061310",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kayla Kristine Meyer
• Kevin Monahan, PHARMD
• Lisa Suzanne Newquist, DT
• Andrea Elise O'Dell, PHARMD
• Shane Ruggless, D.M.D.

• Family Medicine Physician in Auburn, IL
• Providers in Auburn, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.