Glenn A Pederson

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

R878258 Issued in MS

Practice address

1850 Chadwick Dr
Jackson, MS 39204-3404

Phone

(601) 376-2944

NPI assigned

Dec 19, 2007

Sex

Male

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 FL

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

Specialty

Nurse Practitioner

Education

Other, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Paragon Emergency Services LLCGroup PAC ID 8628153087, 401 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: glenn.pederson@direct.baptistfirst.org

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.

• Paragon Emergency Services LLC

  • Emergency Medicine Physician
  • Winter Haven, FL
  • NPI 1912101650
  Medicare reassignment Care Compare group NPD
• Adventist Health System Sunbelt, Inc.

  • Urgent Care Clinic/Center
  • Maitland, FL
  • NPI 1073565610
  Medicare reassignment NPD
• Adventist Health System/ Sunbelt, Inc.

  • Urgent Care Clinic/Center
  • The Villages, FL
  • NPI 1396605440
  NPD
• Adventist Health System/Sunbelt, Inc.

  • Urgent Care Clinic/Center
  • Winter Park, FL
  • NPI 1770770562
  NPD
• Mississippi Em-I Medical Services PC

  • Nurse Practitioner
  • De Kalb, MS
  • NPI 1407412976
  NPD (past)
• West Florida Radiology Associates PA

  • Diagnostic Radiology Physician
  • Milton, FL
  • NPI 1396724654
  NPD (past)

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

{
    "created_epoch": "1198022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1278633600000",
    "number": "1811171408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18167 US HIGHWAY 19 N",
            "address_2": "SUITE 285",
            "city": "CLEARWATER",
            "state": "FL",
            "postal_code": "337643528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 CHADWICK DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392043404",
            "telephone_number": "601-376-2944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEDERSON",
        "first_name": "GLENN",
        "middle_name": "A",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-12-19",
        "last_updated": "2010-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "R878258",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "ARNP1604312",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sherhonda L Pearson, PCMHT
• Charlotte Peavie, CFNP
• Collier Peavy, FNP-C
• Ashley Elizabeth Peden, NP
• Randall Ashley Peden, FNP-C
• Pediatric Dentistry, P.a.
• Pediatric Orthopaedic Specialists of Mississippi
• Jonathan R Peeden, PHARM.D.
• Chere Hunter Peel, M.D.
• Holly Peeples, M.D.

• Nurse Practitioner in Jackson, MS
• Providers in Jackson, MS by specialty
• Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.