NPIMap

Individual provider Active NPI

Jason A. Glenn, P.A.

  • Physician Assistant
  • Springfield, MO
National Provider Identifier
1962420547
Registry record updated Jul 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2003025739 Issued in MO
Practice address
1965 S Fremont Ave Ste 130
Springfield, MO 65804-2252
Phone
(417) 820-5150
Fax
(417) 820-5155
NPI assigned
Jul 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 2003025739 MO Primary

Addresses

Primary practice location

1965 S Fremont Ave Ste 130
Springfield, MO 65804-2252

Mailing address

PO Box 2580
Springfield, MO 65801-2580
Phone (417) 829-4620

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040217001188 MO Practitioner - Physician Assistant 9830084995 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinic Springfield Communities 1,121 clinicians
Healing Arts Center L.L.C. 66 clinicians

Practice addresses (Care Compare)

1235 E Cherokee St
Springfield, MO 65804-2203

1605 Martin Springs Dr
Rolla, MO 65401-2980

225 Violyn Dr
Branson, MO 65616-8128
Phone 4173346660402

Hospital & facility affiliations

  • Mercy Hospital Springfield Hospital, Springfield, MO, CCN 260065
  • Mercy Hospital Lebanon Hospital, Lebanon, MO, CCN 260059

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Springfield Communities CurrentSince Oct 27, 2003 Accepting new patients
Mercy Clinic Joplin LLC CurrentSince Dec 29, 2017 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Oct 27, 2003 Accepting new patients
Mercy Clinic Springfield Communities Past Accepting new patients
Ozarks Medical Center Past Accepting new patients

Locations

290 Clift Ct
#H
Hollister, MO 65672
Phone (417) 336-4355

1717 S Range Line Rd
Ste B
Joplin, MO 64804
Phone (417) 556-2231

100 Mercy Way
Joplin, MO 64804
Phone (417) 556-2300

1605 Martin Springs Dr
Rolla, MO 65401
Phone (573) 458-6379

1605 Martin Springs Dr
Ste 330
Rolla, MO 65401
Phone (573) 458-6379

1965 S Fremont Ave
Ste 130
Springfield, MO 65804
Phone (417) 820-5150

2115 S Fremont Ave
Ste 3050
Springfield, MO 65804
Phone (417) 820-3905

1235 E Cherokee St
Springfield, MO 65804
Phone (417) 820-2115

Interoperability endpoints

  • Direct secure messaging: jglenn18267@directc.mercy.net

Ownership & related parties

All facility ownership & control disclosures 15

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Mercy Clinic Family Medicine - SteelvilleSteelville, MO, CCN 263850 Rural health clinic Corporate Director Jul 1, 2022
Mercy Clinic - St. JamesSaint James, MO, CCN 263943 Rural health clinic Corporate Director Jul 1, 2022
Mercy Clinic - St. RobertSaint Robert, MO, CCN 263813 Rural health clinic Corporate Director Jul 1, 2022
Mercy Clinic Pediatrics-RollaRolla, MO, CCN 268935 Rural health clinic Corporate Director Jul 1, 2022
Mercy Clinic Family Medicine - Mountain GroveMountain Grove, MO, CCN 263840 Rural health clinic Corporate Director Jul 1, 2022
Mercy Clinic Family Medicine-Branson WestBranson West, MO, CCN 263918 Rural health clinic Corporate Director Jul 1, 2022
Mercy Clinic Family Medicine- CassvilleCassville, MO, CCN 263909 Rural health clinic Corporate Director Jul 1, 2022
Mercy Clinic Family Medicine-El Dorado SpringsEl Dorado Springs, MO, CCN 263900 Rural health clinic Corporate Director Jul 1, 2022
Mercy Clinic Pediatrics-LebanonLebanon, MO, CCN 263831 Rural health clinic Corporate Director Jul 1, 2022
Mercy Clinic Family Medicine-BuffaloBuffalo, MO, CCN 263921 Rural health clinic Corporate Director Jul 1, 2022
Mercy Clinic-Lebanon-Family MedicineLebanon, MO, CCN 263814 Rural health clinic Corporate Director Jul 1, 2022
Mercy Clinic Family Medicine-RichlandRichland, MO, CCN 263934 Rural health clinic Corporate Director Jul 1, 2022
Mercy Clinic - Birch TreeBirch Tree, MO, CCN 263806 Rural health clinic Corporate Director Jul 1, 2022
Mercy Clinic -SalemSalem, MO, CCN 263870 Rural health clinic Corporate Director Jul 1, 2022
Mercy Clinic Family Medicine-Mountain ViewMountain View, MO, CCN 263819 Rural health clinic Corporate Director Jul 1, 2022

Owned or controlled facilities with NPI records 15

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 15

Organizations & group practices 7

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.

Hospital & facility affiliations 11

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": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216080000000",
    "number": "1962420547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2580",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658012580",
            "telephone_number": "417-829-4620",
            "fax_number": "417-829-4316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1965 S FREMONT AVE STE 130",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658042252",
            "telephone_number": "417-820-5150",
            "fax_number": "417-820-5155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLENN",
        "first_name": "JASON",
        "middle_name": "A.",
        "name_prefix": "Mr.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2008-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2003025739",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MO

Sources for this page

Verify at the official NPI Registry.