Active NPI
Glenn D Zausmer, DO
- Urology Physician
- Twin Falls, ID
National Provider Identifier
1891767745
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- License
- DO154497
- Practice address
- 775 Pole Line Rd W
Suite 301
Twin Falls, ID 83301-5814 - Phone
- (208) 814-8700
- Fax
- (208) 933-4914
- NPI assigned
- Feb 5, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician | 208800000X | 5101012942 | MI | |
| Urology Physician | 208800000X | DO154497 | OR | Primary |
Addresses
Primary practice location
775 Pole Line Rd W
Suite 301
Twin Falls, ID 83301-5814
Mailing address
190 E Bannock St
Boise, ID 83712-6241
Phone (208) 367-5170
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891767745 | Medicaid | ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5101012942 | MI | MD | Urology Physician |
| DO154497 | OR | MD | Urology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| DCF | Urology | Past | Accepting new patients |
| DCF | Past | Accepting new patients | |
| St Luke'S Magic Valley Regional Medical Center LTD | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Community/Retail Pharmacy
- Twin Falls, ID
- NPI 1760203921
-
- Clinical Medical Laboratory
- Abilene, TX
- NPI 1174904551
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139097600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1418083200000",
"number": "1891767745",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "190 E BANNOCK ST",
"city": "BOISE",
"state": "ID",
"postal_code": "837126241",
"telephone_number": "208-367-5170",
"fax_number": "208-367-5180"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "775 POLE LINE RD W",
"address_2": "SUITE 301",
"city": "TWIN FALLS",
"state": "ID",
"postal_code": "833015814",
"telephone_number": "208-814-8700",
"fax_number": "208-933-4914"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZAUSMER",
"first_name": "GLENN",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-05",
"last_updated": "2014-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "MI",
"license": "5101012942",
"primary": false
},
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "OR",
"license": "DO154497",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1891767745",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Twin Falls, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.