Organization Active NPI

Glen P Morehead MD Inc

  • Medical Oncology Physician
  • Palm Springs, CA
National Provider Identifier
1962004804
Registry record updated Mar 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Oncology PhysicianTaxonomy code 207RX0202X
Legal business name
GLEN P MOREHEAD MD INC
Practice address
1180 N Indian Canyon Dr Ste E218
Palm Springs, CA 92262-4885
Phone
(760) 416-4800
NPI assigned
Nov 16, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2021

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

Authorized official

Name
Glen P Morehead, M.D.NPI 1720169386
Title
President
Phone
(760) 619-2309

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Oncology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RX0202X Primary

Addresses

Primary practice location

1180 N Indian Canyon Dr Ste E218
Palm Springs, CA 92262-4885

Mailing address

51753 El Dorado Dr
La Quinta, CA 92253-9034
Phone (760) 619-2309

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210420002877 CA Part B Supplier - Clinic/Group Practice 3678981289 Receives reassigned benefits from 1 practitioner
Practice locations: Palm Springs, CA

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.

NPI Registry JSON

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

{
    "created_epoch": "1605484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614643200000",
    "number": "1962004804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "51753 EL DORADO DR",
            "city": "LA QUINTA",
            "state": "CA",
            "postal_code": "922539034",
            "telephone_number": "760-619-2309",
            "fax_number": "866-428-0708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1180 N INDIAN CANYON DR STE E218",
            "city": "PALM SPRINGS",
            "state": "CA",
            "postal_code": "922624885",
            "telephone_number": "760-416-4800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLEN P MOREHEAD MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-16",
        "last_updated": "2021-03-02",
        "certification_date": "2021-03-02",
        "status": "A",
        "authorized_official_last_name": "MOREHEAD",
        "authorized_official_first_name": "GLEN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "760-619-2309",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RX0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Medical Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Palm Springs, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.