Individual provider Active NPI

Glen Bowman, MD

  • Anesthesiology Physician
  • Phoenix, AZ
National Provider Identifier
1922110238
Registry record updated Jul 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
73631 Issued in AZ
Practice address
350 W Thomas Rd
Attn: Bni Surgical Suite
Phoenix, AZ 85013
Phone
(602) 406-3541
NPI assigned
Aug 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X G185046 CA
Anesthesiology Physician 207L00000X 319122-1205 UT
Anesthesiology Physician 207L00000X 73631 AZ Primary

Addresses

Primary practice location

350 W Thomas Rd
Attn: Bni Surgical Suite
Phoenix, AZ 85013

Mailing address

240 W Thomas Rd # 301
Phoenix, AZ 85013-4407
Phone (602) 406-6238

Other practice location 1

1900 Sullivan Ave
Daly City, CA 94015-2200
Phone (408) 354-9254

Other identifiers 13

IdentifierTypeStateIssuer
TPRA09326OtherUTMOLINA
2090168OtherUTUNITED HEALTHCARE
107028042101OtherUTIHC
77515OtherUTPEHP
806868300MedicaidID
851001OtherUTDESERET MUTUAL
858409MedicaidAZ
100503208MedicaidNV
119647200MedicaidWY
1502954OtherUTUMWA
QM0000075886OtherUTALTIUS
835388OtherUTHEALTHY U
870545614BOWOtherUTEDUCATORS MUTUAL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT, CA, AZ3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20040205001294 UT Practitioner - Anesthesiology 8123911740 Reassigns benefits to 1 organization
I20230922002448 CA Practitioner - Anesthesiology 8123911740 Reassigns benefits to 1 organization
I20240625002965 AZ Practitioner - Anesthesiology 8123911740 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sjhmc Physician ServicesGroup PAC ID 4486646197, 645 clinicians

Practice addresses (Care Compare)

500 W Thomas Rd
680 DHMG St Joseph's Pelvic Pain and Surg
Phoenix, AZ 85013-4235
Phone (602) 406-6017

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
73631AZMDAnesthesiology Physician
G185046CAMDAnesthesiology Physician
319122-1205UTMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sjhmc Physician Services CurrentSince Jul 1, 2024 Accepting new patients
St. Joseph's Hospital and Medical Center CurrentSince Aug 30, 2020 Accepting new patients
Anesthesia Care Consultants Inc Anesthesiology CurrentSince Sep 15, 2023 Accepting new patients
St. Joseph's Outpatient Surgery Center, LLC Current Accepting new patients
Mountain West Anesthesia LLC Anesthesiology CurrentSince Jul 1, 2004 Accepting new patients

Locations

350 W Thomas Rd
Phoenix, AZ 85013
Phone (480) 339-5001

240 W Thomas Rd
#301
Phoenix, AZ 85013
Phone (602) 406-6262

500 W Thomas Rd
Ste 680
Phoenix, AZ 85013
Phone (602) 406-6017

1849 Bayshore Hwy
#3
Burlingame, CA 94010

1900 Sullivan Ave
Daly City, CA 94015
Phone (650) 991-6503

File 56765
Los Angeles, CA 90074

104 Saint Matthews Ave
San Mateo, CA 94401
Phone (650) 344-8700

3340 N Center St
Ste 800
Lehi, UT 84043
Phone (800) 501-4788

3741 W 12600 S
Riverton, UT 84065
Phone (801) 285-2400

150 W Civic Center Dr
Ste 200
Sandy, UT 84070
Phone (801) 727-2056

1380 E Medical Center Dr
#P
St George, UT 84790
Phone (435) 251-2355

Interoperability endpoints

  • Direct secure messaging: gbowman682498@hisp.ehr.sutterhealth.org

Organizations & group practices 5

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.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721347200000",
    "number": "1922110238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 W THOMAS RD # 301",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850134407",
            "telephone_number": "602-406-6238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 W THOMAS RD",
            "address_2": "ATTN: BNI SURGICAL SUITE",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85013",
            "telephone_number": "602-406-3541"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1900 Sullivan Ave",
            "address_purpose": "LOCATION",
            "city": "Daly City",
            "state": "CA",
            "postal_code": "940152200",
            "country_code": "US",
            "telephone_number": "408-354-9254",
            "fax_number": "918-213-4399",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOWMAN",
        "first_name": "GLEN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2024-07-19",
        "certification_date": "2024-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "G185046",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "UT",
            "license": "319122-1205",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "AZ",
            "license": "73631",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MOLINA",
            "identifier": "TPRA09326",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "2090168",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IHC",
            "identifier": "107028042101",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PEHP",
            "identifier": "77515",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806868300",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DESERET MUTUAL",
            "identifier": "851001",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "858409",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100503208",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119647200",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UMWA",
            "identifier": "1502954",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALTIUS",
            "identifier": "QM0000075886",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHY U",
            "identifier": "835388",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EDUCATORS MUTUAL",
            "identifier": "870545614BOW",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.