NPIMap

Organization Active NPI

Edwin C. Glass, M.D., Inc.

  • Nuclear Medicine Physician
  • Santa Monica, CA
National Provider Identifier
1912019423
Registry record updated Jul 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nuclear Medicine PhysicianTaxonomy code 207U00000X
License
C35240 Issued in CA
Legal business name
EDWIN C. GLASS, M.D., INC.
Practice address
2811 Wilshire Blvd
Suite 810
Santa Monica, CA 90403-4801
Phone
(310) 829-9788
Fax
(310) 264-1649
NPI assigned
Aug 31, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2007

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

Authorized official

Name
Edwin C. Glass, M.D.NPI 1629012612
Title
Owner
Phone
(310) 390-0761

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Nuclear Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207U00000X C35240 CA Primary
Nuclear Cardiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207UN0901X
Nuclear Imaging & Therapy PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207UN0902X
In Vivo & In Vitro Nuclear Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207UN0903X

Addresses

Primary practice location

2811 Wilshire Blvd
Suite 810
Santa Monica, CA 90403-4801

Mailing address

3271 Rosewood Ave.
Los Angeles, CA 90066-1735
Phone (310) 390-0761

Other identifiers 1

IdentifierTypeStateIssuer
00C352400OtherCABLUE SHIELD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184284800000",
    "number": "1912019423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3271 ROSEWOOD AVE.",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900661735",
            "telephone_number": "310-390-0761",
            "fax_number": "310-264-1649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2811 WILSHIRE BLVD",
            "address_2": "SUITE 810",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904034801",
            "telephone_number": "310-829-9788",
            "fax_number": "310-264-1649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDWIN C. GLASS, M.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2007-07-13",
        "status": "A",
        "authorized_official_last_name": "GLASS",
        "authorized_official_first_name": "EDWIN",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "310-390-0761",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207U00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nuclear Medicine",
            "state": "CA",
            "license": "C35240",
            "primary": true
        },
        {
            "code": "207UN0901X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nuclear Medicine, Nuclear Cardiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207UN0902X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nuclear Medicine, Nuclear Imaging & Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207UN0903X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nuclear Medicine, In Vivo & In Vitro Nuclear Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "00C352400",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Monica, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.