Individual provider Active NPI

Glenn Daniel Shupe, CRNA

  • Certified Registered Nurse Anesthetist
  • Phoenix, AZ
National Provider Identifier
1821072455
Registry record updated May 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
RN130186 Issued in AZ
Practice address
5777 E Mayo Blvd
Phoenix, AZ 85054-4502
Phone
(480) 301-8000
NPI assigned
Dec 6, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X RN130186 AZ Primary

Addresses

Primary practice location

5777 E Mayo Blvd
Phoenix, AZ 85054-4502

Mailing address

5777 E Mayo Blvd
Phoenix, AZ 85054-4502
Phone (480) 301-8000

Other identifiers 4

IdentifierTypeStateIssuer
893158MedicaidAZ
86080015085259A968OtherAZTRIWEST
86080015085260A111OtherAZTRIWEST
P00169405OtherAZRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041124000787 AZ Practitioner - Certified Registered Nurse Anesthetist (Crna) 9032174446 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Summit Anesthesia Services PLLCGroup PAC ID 3971850892, 49 clinicians

Practice addresses (Care Compare)

3929 E Bell Rd
Phoenix, AZ 85032-2112
Phone (623) 923-5000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Ascend Anesthesia LLC Nurse Anesthetist, Certified Registered CurrentSince Jun 1, 2025 Accepting new patients
Summit Anesthesia Services PLLC Nurse Anesthetist, Certified Registered CurrentSince Dec 1, 2022 Accepting new patients
Anesthesia Partners & Management LLC Nurse Anesthetist, Certified Registered CurrentSince May 13, 2020 Accepting new patients
Novaspine Pain Institute, PLC CurrentSince Mar 1, 2023 Accepting new patients
Novaspine Pain Institute, PLC CurrentSince Mar 1, 2023 Accepting new patients
Integrated Anesthesia Consultants PLC CurrentSince Feb 1, 2022 Accepting new patients
Pinnacle Global Health LLC Past Accepting new patients

Locations

900 N San Francisco St
Flagstaff, AZ 86001
Phone (928) 779-7000

1020 N San Francisco St
Ste 100
Flagstaff, AZ 86001
Phone (928) 774-2300

2450 E Guadalupe Rd
Ste 101
Gilbert, AZ 85234
Phone (480) 398-8456

3615 S Rome St
Gilbert, AZ 85297
Phone (480) 245-4425

3420 S Mercy Rd
Ste 200
Gilbert, AZ 85297
Phone (480) 909-3787

18555 N 79th Ave
Bldg C
Glendale, AZ 85308
Phone (623) 776-2500

103 Medicine Way Rd
Peridot, AZ 85542
Phone (928) 475-1200

1902 W Union Hills Dr
Unit 41340
Phoenix, AZ 85080

4600 E Washington St
Ste 300
Phoenix, AZ 85034
Phone (602) 638-1872

3900 E Camelback Rd
Ste 190
Phoenix, AZ 85018
Phone (888) 724-6236

1902 W Union Hills Dr
Unit 41550
Phoenix, AZ 85080

3929 E Bell Rd
Phoenix, AZ 85032
Phone (602) 923-5000

7301 N 16th St
Ste 102
Phoenix, AZ 85020
Phone (602) 772-8600

3110 Clearwater Dr
Prescott, AZ 86305
Phone (623) 241-6185

5430 Distinction Way
Prescott, AZ 86301
Phone (928) 445-1919

8952 E Desert Cove Ave
Ste 113
Scottsdale, AZ 85260
Phone (480) 314-7772

10494 W Thunderbird Blvd
Ste 102
Sun City, AZ 85351
Phone (623) 975-8311

13203 N 103rd Ave
Ste H5
Sun City, AZ 85351
Phone 62377747474789

10503 W Thunderbird Blvd
Ste 317
Sun City, AZ 85351
Phone (623) 546-1400

14300 W Granite Valley Dr
Ste A1
Sun City West, AZ 85375
Phone (602) 546-4934

1704 W Anklam Rd
Ste 108
Tucson, AZ 85745
Phone (623) 241-6185

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1133827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526342400000",
    "number": "1821072455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5777 E MAYO BLVD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850544502",
            "telephone_number": "480-301-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5777 E MAYO BLVD",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850544502",
            "telephone_number": "480-301-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHUPE",
        "first_name": "GLENN",
        "middle_name": "DANIEL",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-06",
        "last_updated": "2018-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AZ",
            "license": "RN130186",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "893158",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRIWEST",
            "identifier": "86080015085259A968",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRIWEST",
            "identifier": "86080015085260A111",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00169405",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.