Dr Glenn Sample, PSYD is a medicare enrolled "Psychologist - Clinical" provider in Rockford, Illinois. He graduated from healthcare school in 2013 and has 13 years of diverse experience with area of expertise as Clinical Psychologist. His current practice location is
1643 N Alpine Rd Ste 104-609, Rockford, Illinois. You can reach out to his office (for appointments etc.) via phone at
(773) 245-3449.
Dr Glenn Sample is licensed to practice in Illinois (license number 071009666) and he also participates in the medicare program. He
may accept medicare assignments (which means he may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance) and his NPI Number is 1881915270.
Healthcare Provider's Profile
| Full Name | Dr Glenn Sample |
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| Gender | Male |
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| Speciality | Clinical Psychologist |
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| Experience | 13 Years |
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| Location | 1643 N Alpine Rd Ste 104-609, Rockford, Illinois |
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| Accepts Medicare Assignments | May be. He may accept the Medicare-approved amount; you may be billed for more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Dr Glenn Sample graduated from medical school in 2013
NPI Data:
- NPI Number: 1881915270
- Provider Enumeration Date: 06/20/2010
- Last Update Date: 03/08/2026
Medicare PECOS Information:
- PECOS PAC ID: 4284993973
- Enrollment ID: I20180126000958
Medical Identifiers
Medical identifiers for Dr Glenn Sample such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1881915270 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 101YP2500X | Counselor - Professional | 178010086 (Illinois) | Secondary |
| 103TC0700X | Psychologist - Clinical | 30340 (California) | Secondary |
| 101YP2500X | Counselor - Professional | 180010078 (Illinois) | Secondary |
| 103TC0700X | Psychologist - Clinical | 071009666 (Illinois) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Glenn Sample is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Glenn Sample, PSYD
1643 N Alpine Rd Ste 104-609,
Rockford, IL 61107-1462
Ph: (773) 245-3449 | Dr Glenn Sample, PSYD
1643 N Alpine Rd Ste 104-609,
Rockford, IL 61107-1462
Ph: (773) 245-3449 |
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