Organization Active NPI

Glen C. Cangelosi MD LLC

  • Ophthalmology Physician
  • New Orleans, LA
National Provider Identifier
1972645448
Registry record updated Jul 2, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
016166 Issued in LA
Legal business name
GLEN C. CANGELOSI MD LLC
Practice address
4201 Frenchmen St
New Orleans, LA 70122-3839
Phone
(504) 282-7212
Fax
(504) 282-7657
NPI assigned
Feb 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2009

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

Authorized official

Name
Mrs. Doris Faye L Polito
Title
Insurance Clerk Bookkeeper
Phone
(504) 282-7212

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X 016166 LA Primary

Addresses

Primary practice location

4201 Frenchmen St
New Orleans, LA 70122-3839

Mailing address

4201 Frenchmen St
New Orleans, LA 70122-3839
Phone (504) 282-7212

Other identifiers 1

IdentifierTypeStateIssuer
1349259MedicaidLA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070227000132 LA Part B Supplier - Clinic/Group Practice 5890897557 Receives reassigned benefits from 6 practitioners
Practice locations: New Orleans, LA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1246492800000",
    "number": "1972645448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4201 FRENCHMEN ST",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701223839",
            "telephone_number": "504-282-7212",
            "fax_number": "504-282-7657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4201 FRENCHMEN ST",
            "city": "NEW ORLEANS",
            "state": "LA",
            "postal_code": "701223839",
            "telephone_number": "504-282-7212",
            "fax_number": "504-282-7657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLEN C. CANGELOSI MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-13",
        "last_updated": "2009-07-02",
        "status": "A",
        "authorized_official_last_name": "POLITO",
        "authorized_official_first_name": "DORIS FAYE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "INSURANCE CLERK  BOOKKEEPER",
        "authorized_official_telephone_number": "504-282-7212",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "LA",
            "license": "016166",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1349259",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New Orleans, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2009; 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.