NPIMap

Individual provider Active NPI

Glen J. Dasher, M.D.

  • Family Medicine Physician
  • Statesboro, GA
National Provider Identifier
1972684546
Registry record updated Aug 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
043354 Issued in GA
Practice address
1140 Brampton
Statesboro, GA 30458
Phone
(912) 871-2273
Fax
(912) 871-2274
NPI assigned
Oct 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 043354 GA Primary

Addresses

Primary practice location

1140 Brampton
Statesboro, GA 30458

Mailing address

1140 Brampton Ave
Statesboro, GA 30458
Phone (912) 871-2273

Other identifiers 1

IdentifierTypeStateIssuer
000766114EMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20040308000573 GA Practitioner - Family Practice 3072414564 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical College of Georgia School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Southern Family Medicine of Georgia, LLCGroup PAC ID 6608914056, 10 clinicians

Practice addresses (Care Compare)

1140 Brampton Ave
Statesboro, GA 30458-0847
Phone 9128712273128

308 E Long St
Claxton, GA 30417-1412
Phone 9122905235209

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions64
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Family Medicine of Georgia, LLC Family Medicine CurrentSince Sep 25, 2009 Accepting new patients
Evans Emergency Group LLC Past Accepting new patients
Evans Memorial Hospital, Inc. Past Accepting new patients
SMG-Occupational Health Clinic PastSince May 21, 2023 Accepting new patients
Glenvue Operations LLC Past Accepting new patients

Locations

308 E Long St
Claxton, GA 30417
Phone (912) 290-5235

1044 Bermuda Run
Statesboro, GA 30458
Phone (912) 871-2273

1140 Brampton Ave
Statesboro, GA 30458
Phone (912) 871-2273

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JEEICD
  • Direct secure messaging: glen.dasher@sfmgac.eclinicaldirectplus.com

Organizations & group practices 5

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 10

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": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691452800000",
    "number": "1972684546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1140 BRAMPTON AVE",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "30458",
            "telephone_number": "912-871-2273",
            "fax_number": "912-871-2274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1140 BRAMPTON",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "30458",
            "telephone_number": "912-871-2273",
            "fax_number": "912-871-2274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DASHER",
        "first_name": "GLEN",
        "middle_name": "J.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-18",
        "last_updated": "2023-08-08",
        "certification_date": "2023-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "043354",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000766114E",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Statesboro, GA

Sources for this page

Verify at the official NPI Registry.