Kristen M Glick, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

2772 Issued in CT

Practice address

267 Grant St
Bridgeport, CT 06610-2805

Phone

(203) 384-3693

Fax

(203) 384-3693

NPI assigned

Oct 30, 2008

Last updated

Aug 28, 2014By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CT

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kglick104676@direct.ynhh.org

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.

• Bridgeport Hospital

  • General Acute Care Hospital
  • Bridgeport, CT
  • NPI 1649260845
  Medicare reassignment
• Bridgeport Hospital

  dba Bridgeport Hospital Milford Campus OP

  • General Acute Care Hospital
  • Milford, CT
  • NPI 1891376810
  NPD

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

{
    "created_epoch": "1225324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1409184000000",
    "number": "1760635080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "267 GRANT ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066102805",
            "telephone_number": "203-384-3693",
            "fax_number": "203-384-3693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "267 GRANT ST",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066102805",
            "telephone_number": "203-384-3693",
            "fax_number": "203-384-3693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLICK",
        "first_name": "KRISTEN",
        "middle_name": "M",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-30",
        "last_updated": "2014-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "012938",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CT",
            "license": "2772",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gina M Givogre, PA
• Selvator Gjoka, DMD
• Austin Gleaton
• Michael Glendon
• Assan Glenn
• Luciana Gliga, AGACNP-BC
• Melanie Glynn
• David Goffman, PHARMD
• Danielle Gofman, MA, LPC, C-DBT
• Rimma Gofman, LMFT

• Physician Assistant in Bridgeport, CT
• Providers in Bridgeport, CT by specialty
• Physician Assistant in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2014; 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.