Individual provider Active NPI

Glendon P Rougeou, MD

  • Family Medicine Physician
  • San Francisco, CA
National Provider Identifier
1992719371
Registry record updated Oct 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
070764 Issued in GA
Practice address
1 California St Ste 2300
San Francisco, CA 94111-5424
Phone
(415) 504-3838
Fax
(415) 504-1367
NPI assigned
Jul 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2022

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

Specialties & licenses 15

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036159042 IL
Family Medicine Physician 207Q00000X MD61258786 WA
Family Medicine Physician 207Q00000X T6468 TX
Family Medicine Physician 207Q00000X MD-49368 IA
Family Medicine Physician 207Q00000X 65671 AZ
Family Medicine Physician 207Q00000X 070764 GA Primary
Family Medicine Physician 207Q00000X 52347 KY
Family Medicine Physician 207Q00000X 87337 SC
Family Medicine Physician 207Q00000X 329649 LA
Family Medicine Physician 207Q00000X ME138774 FL
Family Medicine Physician 207Q00000X 21854 NV
Family Medicine Physician 207Q00000X DR.0060480 CO
Family Medicine Physician 207Q00000X MD466294 PA
Family Medicine Physician 207Q00000X 62246 CT
Family Medicine Physician 207Q00000X 58719 TN

Addresses

Primary practice location

1 California St Ste 2300
San Francisco, CA 94111-5424

Mailing address

1 California St Ste 2300
San Francisco, CA 94111-5424
Phone (415) 504-3838

Other identifiers 1

IdentifierTypeStateIssuer
5907241MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20071108000141 NC Practitioner - Family Practice 5799709077 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Louisiana State University School of Medicine in Shreveport, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wake Forest University Health SciencesGroup PAC ID 4486564952, 2,633 clinicians

Practice addresses (Care Compare)

1404 Willow LN
Suite a
North Wilkesboro, NC 28659-3584
Phone (336) 667-4178

Hospital & facility affiliations

  • North Carolina Baptist Hospital Hospital, Winston-Salem, NC, CCN 340047
  • Lexington Memorial Hospital Inc Hospital, Lexington, NC, CCN 340096
  • Novant Health Thomasville Medical Center Hospital, Thomasville, NC, CCN 340085

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
65671AZMDFamily Medicine Physician
DR.0060480COMDFamily Medicine Physician
62246CTMDFamily Medicine Physician
ME138774FLMDFamily Medicine Physician
MD-49368IAMDFamily Medicine Physician
036159042ILMDFamily Medicine Physician
52347KYMDFamily Medicine Physician
329649LAMDFamily Medicine Physician
21854NVMDFamily Medicine Physician
MD466294PAMDFamily Medicine Physician
87337SCMDFamily Medicine Physician
58719TNMDFamily Medicine Physician
T6468TXMDFamily Medicine Physician
MD61258786WAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Wake Forest University Health Sciences CurrentSince Jun 5, 2023 Accepting new patients
Urgent Care Clinic of Lincoln, P.C. Past Accepting new patients

Locations

3150 N Elm St
Greensboro, NC 27408
Phone (336) 716-7811

1534 W D St
North Wilkesboro, NC 28659
Phone (336) 667-4178

1404 Willow Ln
Ste A
North Wilkesboro, NC 28659
Phone (336) 667-4178

711 National Hwy
Ste 100
Thomasville, NC 27360
Phone (336) 475-2000

1930 N Peace Haven Rd
Winston Salem, NC 27106
Phone (336) 760-5400

100 Kimel Forest Dr
Winston Salem, NC 27103
Phone (336) 713-0947

Medical Ctr Blvd
Winston Salem, NC 27157
Phone (336) 713-2697

Interoperability endpoints

  • Direct secure messaging: grougeou2754268@carolinashealthcaresystem.direct-ci.com

Organizations & group practices 2

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 7

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": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667174400000",
    "number": "1992719371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CALIFORNIA ST STE 2300",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941115424",
            "telephone_number": "415-504-3838",
            "fax_number": "415-504-1367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 CALIFORNIA ST STE 2300",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941115424",
            "telephone_number": "415-504-3838",
            "fax_number": "415-504-1367"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROUGEOU",
        "first_name": "GLENDON",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2022-10-31",
        "certification_date": "2022-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036159042",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD61258786",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "T6468",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IA",
            "license": "MD-49368",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "65671",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "070764",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "52347",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "SC",
            "license": "87337",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "LA",
            "license": "329649",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME138774",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NV",
            "license": "21854",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "DR.0060480",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD466294",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CT",
            "license": "62246",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "58719",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5907241",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Francisco, CA

Sources for this page

Verify at the official NPI Registry.