Jacquelyn Kay Glenn, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

40730-020 Issued in WI

Practice address

10103 Ridgegate Pkwy Ste 309
Lone Tree, CO 80124-5525

Phone

(720) 820-9455

Fax

(303) 736-4226

NPI assigned

Oct 23, 2006

Last updated

Jan 23, 2023By 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 1

Addresses

Other identifiers 1

Other names 1

• Dr. Jacquelyn Kay O'Herrin Former name

Medicare fee-for-service enrollment

Enrolled in CO

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

Specialty

General Surgery

Education

University of Colorado School of Medicine, Denver, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• Surgical Specialists of Colorado PLLC

  dba Peak Surgical & Wound Care

  • Surgery Physician
  • Lone Tree, CO
  • NPI 1487026951
  Medicare reassignment NPD Authorized official
• Tacss PLLC

  • Surgery Physician
  • Lone Tree, CO
  • NPI 1578954822
  Medicare reassignment NPD Authorized official
• Colorado Surgical and Critical Care Associates PLLC

  • Surgery Physician
  • Aurora, CO
  • NPI 1295846426
  Medicare reassignment NPD
• Surgical Specialists of Colorado PLLC

  • Surgery Physician
  • Lone Tree, CO
  • NPI 1689042939
  NPD Authorized official
• Colorado Plains Physician Practices LLC

  • Cardiovascular Disease Physician
  • Fort Morgan, CO
  • NPI 1821042409
  NPD
• Centerpointe Health Partners

  • Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
  • Centennial, CO
  • NPI 1770381659
  NPD (past)
• Colorado Medical Group, PLLC

  dba United Vein Centers of Centennial, CO

  • Vascular Surgery Physician
  • Englewood, CO
  • NPI 1053928234
  NPD (past)

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674432000000",
    "number": "1831272822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14100 E ARAPAHOE RD",
            "address_2": "STE 260",
            "city": "CENTENNIAL",
            "state": "CO",
            "postal_code": "801124048",
            "telephone_number": "720-612-1912",
            "fax_number": "303-736-4226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10103 RIDGEGATE PKWY STE 309",
            "city": "LONE TREE",
            "state": "CO",
            "postal_code": "801245525",
            "telephone_number": "720-820-9455",
            "fax_number": "303-736-4226"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14100 E ARAPAHOE RD",
            "address_2": "STE 260",
            "address_purpose": "LOCATION",
            "city": "CENTENNIAL",
            "state": "CO",
            "postal_code": "801124048",
            "country_code": "US",
            "telephone_number": "303-699-3048",
            "fax_number": "303-699-3047",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GLENN",
        "first_name": "JACQUELYN",
        "middle_name": "KAY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-23",
        "last_updated": "2023-01-23",
        "certification_date": "2023-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WI",
            "license": "40730-020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39557272",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELYN",
            "last_name": "O'HERRIN",
            "middle_name": "KAY",
            "prefix": "DR.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Terri Lynn Gilliland, LMT
• Sheri L Gipson, MD
• Chelcie Gjellum, RDH, CSOM
• Kelley K Glancey, MD
• Lauren E Gleckler, M.D.
• Jeffrey J Goates, M.D.
• Erin E. Godbout, MD
• Jill Marie Goding, LPC
• Kyle Goerl, MD
• Dustin Goerlitz, PHD

• Surgery Physician in Lone Tree, CO
• Providers in Lone Tree, CO by specialty
• Surgery Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2023; 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.