Shantel Tanae Glick, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

AZ3142 Issued in AZ

Practice address

21681 N 77TH Ave
Peoria, AZ 85382-2132

Phone

(623) 972-9200

Fax

(623) 972-9209

NPI assigned

Jan 18, 2007

Sex

Female

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 AZ

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

Interoperability endpoints

• Direct secure messaging: shantel.glick.1@24665.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/24665/brand/1/csg/1/fhir/r4

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.

• Glick Medical Group, PLLC

  • Primary Care Clinic/Center
  • Scottsdale, AZ
  • NPI 1285305144
  NPD Authorized official
• Integrative Health Institute LLC

  • General Practice Physician
  • Scottsdale, AZ
  • NPI 1093060717
  NPD
• Banner Sun City Medical Group

  • Multi-Specialty Clinic/Center
  • Sun City, AZ
  • NPI 1902067200
  NPD (past)
• Banner Urgent Care - Surprise

  • Urgent Care Clinic/Center
  • Surprise, AZ
  • NPI 1649406273
  NPD (past)

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1432080000000",
    "number": "1841342631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21681 N 77TH AVE",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853822132",
            "telephone_number": "623-972-9200",
            "fax_number": "623-972-9209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21681 N 77TH AVE",
            "city": "PEORIA",
            "state": "AZ",
            "postal_code": "853822132",
            "telephone_number": "623-972-9200",
            "fax_number": "623-972-9209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLICK",
        "first_name": "SHANTEL",
        "middle_name": "TANAE",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-18",
        "last_updated": "2015-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "AZ3142",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "920513",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "Z159355",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Valerie Alyse Girod, LPC,LASAC
• Daniel Glassman, D.C.
• Jordan J Glenn, DO
• Leah Glenn, REGISTERED NURSE
• Globe Behavioral Health Services LLC
• GN Dental PLLC
• Go Fast Billing LLC
• James Ronald Go
• Gobran Shahla MD PLLC

• Physician Assistant in Peoria, AZ
• Providers in Peoria, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2015; 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.