NPIMap

Individual provider Active NPI

John W. Glick, MD

  • Psychiatry Physician
  • Duluth, MN
National Provider Identifier
1972537652
Registry record updated Jul 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
34387 Issued in MN
Practice address
1406 E 2ND St
Duluth, MN 55805-2378
Phone
(218) 728-4491
Fax
(218) 728-7970
NPI assigned
Jul 10, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 34387 MN Primary

Addresses

Primary practice location

1406 E 2ND St
Duluth, MN 55805-2378

Mailing address

1401 East First Street
Duluth, MN 55805
Phone (218) 728-4491

Other practice location 1

1401 E 1st St
Duluth, MN 55805-2407
Phone (218) 728-4491

Other identifiers 1

IdentifierTypeStateIssuer
696763900MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, MN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040802001531 WI Practitioner - Psychiatry 3274504469 Reassigns benefits to 1 organization
I20120208001056 MN Practitioner - Psychiatry 3274504469 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
University of Minnesota Medical School, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Human Development CenterGroup PAC ID 2961485909, 39 clinicians

Practice addresses (Care Compare)

1401 E 1St St
Duluth, MN 55805-2407
Phone (218) 728-4491

1500 N 34TH St
Suite 100
Superior, WI 54880-4476
Phone (715) 392-8216

Hospital & facility affiliations

  • St Lukes Hospital Hospital, Duluth, MN, CCN 240047

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
34387MNMDPlastic Surgery within the Head & Neck (Otolaryngology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Brightwater Health Dba Human Development Center CurrentSince Nov 1, 2020 Accepting new patients
Brightwater Health Dba Human Development Center CurrentSince Aug 1, 1991 Accepting new patients
St. Luke'S Hospital of Duluth Current Accepting new patients
Brightwater Health Dba Human Development Center Past Accepting new patients
HRC Mental Health Center Past Accepting new patients
Brightwater Health Dba Human Development Center Past Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

40 11th St
Cloquet, MN 55720
Phone (218) 879-4559

1015 E 1st St
Duluth, MN 55805
Phone (218) 249-7860

810 E 4th St
Duluth, MN 55805
Phone (218) 728-4491

1401 E 1st St
Duluth, MN 55805
Phone (218) 728-4491

325 11th Ave
Two Harbors, MN 55616
Phone (218) 834-5520

1500 N 34th St
Ste 200
Superior, WI 54880
Phone (715) 392-8216

1500 N 34th St
Ste 100
Superior, WI 54880
Phone (715) 392-8216

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/humandevelopmentcenter/r4/
  • Direct secure messaging: john.glick.glijo@slk.direct.slhduluth.com

Organizations & group practices 6

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 26

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

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594771200000",
    "number": "1972537652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 EAST FIRST STREET",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "55805",
            "telephone_number": "218-728-4491",
            "fax_number": "218-728-4404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1406 E 2ND ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558052378",
            "telephone_number": "218-728-4491",
            "fax_number": "218-728-7970"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1401 E 1st St",
            "address_purpose": "LOCATION",
            "city": "Duluth",
            "state": "MN",
            "postal_code": "558052407",
            "country_code": "US",
            "telephone_number": "218-728-4491",
            "fax_number": "218-728-4404",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GLICK",
        "first_name": "JOHN",
        "middle_name": "W.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-10",
        "last_updated": "2020-07-15",
        "certification_date": "2020-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MN",
            "license": "34387",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "696763900",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.