Travis Wagner Glenn, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD21270 Issued in HI

Practice address

85 Maui Lani Pkwy
Wailuku, HI 96793-2416

Phone

(808) 244-5766

NPI assigned

Jun 6, 2017

Last updated

Aug 31, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Glenn Travis Wagner Former name

Medicare fee-for-service enrollment

Enrolled in HI

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

Family Practice

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Glenn Family Medicine, LLCGroup PAC ID 8729480744, 3 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Bayada Home Health Care Home health agency, Wailuku, HI, CCN 127309
• Maui Memorial Medical Center Hospital, Wailuku, HI, CCN 120002

Merit-based Incentive Payment System (MIPS)

Final score

27.74 of 100Reported as individual

Quality

15

Improvement activities

0

Cost

72.46

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.

• Glenn Family Medicine, LLC

  • Family Medicine Physician
  • Wailuku, HI
  • NPI 1508443805
  Medicare reassignment Care Compare group NPD Authorized official

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• B.C.P., Inc.

  dba BAYADA Home Health Care

  • Home Health Agency
  • Wailuku, HI
  • NPI 1942569702
  Care Compare affiliation
• Maui Health System a Kaiser Foundation Hospitals LLC

  dba Maui Memorial Medical Center

  • General Acute Care Hospital
  • Wailuku, HI
  • NPI 1013379460
  Care Compare affiliation

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

{
    "created_epoch": "1496707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630368000000",
    "number": "1841729670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "85 MAUI LANI PKWY",
            "city": "WAILUKU",
            "state": "HI",
            "postal_code": "967932416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 MAUI LANI PKWY",
            "city": "WAILUKU",
            "state": "HI",
            "postal_code": "967932416",
            "telephone_number": "808-244-5766"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "221 Mahalani St",
            "address_purpose": "LOCATION",
            "city": "Wailuku",
            "state": "HI",
            "postal_code": "967932526",
            "country_code": "US",
            "telephone_number": "808-244-9056",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GLENN",
        "first_name": "TRAVIS",
        "middle_name": "WAGNER",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-06",
        "last_updated": "2021-08-31",
        "certification_date": "2021-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "HI",
            "license": "MD21270",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GLENN",
            "last_name": "WAGNER",
            "middle_name": "TRAVIS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Giron Corporation
• Leslie Hartley Gise, MD
• Raymond M. Glauser, OD
• Glenn Family Medicine, LLC
• Bradley Holman Glenn, MD
• Kyra R Glover, OTR/L
• Nicholas Scott Goehner, M.D.
• Heather E Goff, MD
• Margaret E. Goldberg, LCSW, CSAC
• Jennifer Gonsalves

• Family Medicine Physician in Wailuku, HI
• Providers in Wailuku, HI by specialty
• Family Medicine Physician in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2021; 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.