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DR. GLEN B SMITH M.D. NPI 1326031105


NPI Information

NPI: 1326031105
Provider Name: DR. GLEN B SMITH, M.D.
Classification: Thoracic Surgery (Cardiothoracic Vascular Surgery) - 208G00000X
Entity Type: Individual

PECOS Registration: Yes

Address:
1505 EASTLAND DR
SUITE 210
BLOOMINGTON, IL
ZIP 61701
Phone: (309) 662-5506
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DR. Glen B Smith, M.D. is a thoracic surgery cardiothoracic vascular surgery in Bloomington, IL with 39 years of experience. The provider is a thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum and diseases of the diaphragm. The management of the airway and injuries of the chest is within the scope of the specialty. DR. Glen B Smith, M.D. NPI is 1326031105. 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:

1505 EASTLAND DR
SUITE 210
BLOOMINGTON, IL
ZIP 61701-906
Phone: (309) 662-5506
Fax: (309) 662-5443

The NPI 1326031105 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 enumeration date for this NPI number is 8/26/2005 and was last updated on 11/13/2012.


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 Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208G00000XThoracic Surgery (Cardiothoracic Vascular Surgery)036075454ILLINOISYes

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 Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1036075454000OTHEROSF HEALTH PLANS
2233989OTHERPERSONAL CARE
3L96846MEDICARE PINILLINOIS
405732036OTHERILLINOISBLUE SHIELD GROUP NUMBER
51955270OTHERUNITED HEALTHCARE
637893OTHERTRICARE
7205477201MEDICAIDMISSOURI
8008131OTHERILLINOISHEALTH ALLIANCE PROVIDER
937773OTHERPHCS
10E57544MEDICARE UPIN
11780002309MEDICARE PIN
12228074OTHERHEALTHLINK
13IL0102OTHERJOHN DEERE HEALTH PLAN
14$$$$$$$$$MEDICAIDILLINOIS

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: 5/5/2024

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.