Individual provider Active NPI

Glenn S. Kanamori, MD

  • Pediatric Otolaryngology Physician
  • Orlando, FL
National Provider Identifier
1972697357
Registry record updated Apr 29, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Otolaryngology PhysicianTaxonomy code 207YP0228X
License
ME115604 Issued in FL
Practice address
1717 S Orange Ave Ste 100
Nemours Childrens Clinic, Orlando
Orlando, FL 32806-2946
Phone
(407) 650-7715
Fax
(407) 650-7124
NPI assigned
Oct 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X G65026 CA
Pediatric Otolaryngology Physician 207YP0228X ME115604 FL Primary

Addresses

Primary practice location

1717 S Orange Ave Ste 100
Nemours Childrens Clinic, Orlando
Orlando, FL 32806-2946

Mailing address

PO Box 191
Provider Enrollment Department
Rockland, DE 19732-0191
Phone (302) 651-4488

Other identifiers 1

IdentifierTypeStateIssuer
00G650260MedicaidCA

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20130620000413 FL Practitioner - Otolaryngology 8729981303 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
ME115604FLMDPediatric Otolaryngology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Nemours Foundation CurrentSince Apr 20, 2013 Accepting new patients
The Nemours Foundation Current Accepting new patients
The Nemours Foundation CurrentSince Apr 20, 2013 Accepting new patients
The Regents of the University of California Past Accepting new patients

Locations

807 Childrens Way
Jacksonville, FL 32207
Phone (904) 390-3600

10140 Centurion Pkwy N
Jacksonville, FL 32256
Phone (904) 697-4100

1270 N Wickham Rd
Melbourne, FL 32935
Phone (321) 266-8251

6535 Nemours Pkwy
Orlando, FL 32827
Phone (407) 567-4000

1717 S Orange Ave
Ste 100
Orlando, FL 32806

Interoperability endpoints

  • Direct secure messaging: gkanamori43040@direct.nemours.org

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1367193600000",
    "number": "1972697357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 191",
            "address_2": "PROVIDER ENROLLMENT DEPARTMENT",
            "city": "ROCKLAND",
            "state": "DE",
            "postal_code": "197320191",
            "telephone_number": "302-651-4488",
            "fax_number": "302-651-4945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 S ORANGE AVE STE 100",
            "address_2": "NEMOURS CHILDRENS CLINIC, ORLANDO",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328062946",
            "telephone_number": "407-650-7715",
            "fax_number": "407-650-7124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANAMORI",
        "first_name": "GLENN",
        "middle_name": "S.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2013-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "CA",
            "license": "G65026",
            "primary": false
        },
        {
            "code": "207YP0228X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Pediatric Otolaryngology",
            "state": "FL",
            "license": "ME115604",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G650260",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.