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GLEN S O'SULLIVAN M.D. NPI 1972504652


NPI Information

NPI: 1972504652
Provider Name: GLEN S O'SULLIVAN, M.D.
Classification: Specialist - 174400000X
Entity Type: Individual

PECOS Registration: Yes

Address:
635 LASSEN LN
MOUNT SHASTA, CA
ZIP 96067
Phone: (866) 668-3597
Get Directions

Glen S O'sullivan, M.D. is a specialist in Mount Shasta, CA with 38 years of experience. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. Glen S O'sullivan, M.D. NPI is 1972504652. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

635 LASSEN LN
MOUNT SHASTA, CA
ZIP 96067-003
Phone: (866) 668-3597
Fax: (866) 301-6641

The NPI 1972504652 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance (HCPCS:64483)
  • Injections of lower or sacral spine facet joint using imaging guidance (HCPCS:64493)
  • X-ray of hip with pelvis, 2-3 views (HCPCS:73502)
  • Injections of lower or sacral spine facet joint using imaging guidance (HCPCS:64494)
  • Insertion of device into intervertebral disc space of spine and fusion of vertebrae (HCPCS:22853)
  • Injection procedure into sacroiliac joint for anesthetic or steroid (HCPCS:27096)
  • Aspiration and/or injection of large joint or joint capsule (HCPCS:20610)
  • Destruction of lower or sacral spinal facet joint nerves using imaging guidance (HCPCS:64635)
  • Partial removal of spine bone with release of spinal cord and/or nerves (HCPCS:63048)
  • X-ray of shoulder, minimum of 2 views (HCPCS:73030)
  • Partial removal of middle spine bone with release of spinal cord and/or nerves (HCPCS:63047)
  • Fusion of spine bones, posterior or posterolateral approach (HCPCS:22614)
  • Insertion of posterior spinal instrumentation for spinal stabilization, 3 to 6 vertebral segments (HCPCS:22842)

The enumeration date for this NPI number is 8/3/2005 and was last updated on 11/23/2010.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1174400000XSpecialistA44219CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1A29768MEDICARE UPINCALIFORNIA
200A442190MEDICARE ID-TYPE UNSPECIFIEDCALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.