Glenn Edward Berry, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

H1689 Issued in TX

Practice address

Oj Baker at Reda Bland Evans
Prairie View, TX 77446

Phone

(936) 857-2511

Fax

(936) 857-4999

NPI assigned

Nov 24, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Ucp Physicians of Central Texas, PLLC

  • Urgent Care Clinic/Center
  • Georgetown, TX
  • NPI 1922289412
  Medicare reassignment NPD
• Ucp Physicians of Central Texas, PLLC

  • Urgent Care Clinic/Center
  • Austin, TX
  • NPI 1154472967
  NPD
• Owens Franklin Health Center, Prairie View a&M University

  • Student Health Clinic/Center
  • Prairie View, TX
  • NPI 1649579533
  NPD (past)

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

{
    "created_epoch": "1164326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1962578831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 457",
            "city": "PRAIRIE VIEW",
            "state": "TX",
            "postal_code": "774460457",
            "telephone_number": "936-857-2511",
            "fax_number": "936-857-4999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "OJ BAKER AT REDA BLAND EVANS",
            "city": "PRAIRIE VIEW",
            "state": "TX",
            "postal_code": "77446",
            "telephone_number": "936-857-2511",
            "fax_number": "936-857-4999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERRY",
        "first_name": "GLENN",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "TX",
            "license": "H1689",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amor Supply
• Christopher Ethan Bartholomew, D.D.S.
• Fort Bend Family Health Center, Inc.
• Maryellen Hole
• Labelle Health Care Services
• Davina Demetria Mitchell
• Cosmas Asonye Nwogwugwu

• Internal Medicine Physician in Prairie View, TX
• Providers in Prairie View, TX by specialty
• Internal Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.