Dr Glenn Richard Gourley, MD in Minneapolis, MN

Dr Glenn Richard Gourley, MD is a medicare enrolled "Pediatrics - Pediatric Gastroenterology" physician in Minneapolis, Minnesota. His current practice location is 3001 Broadway St Ne Ste 500, Minneapolis, Minnesota. You can reach out to his office (for appointments etc.) via phone at (612) 871-1145.

Dr Glenn Richard Gourley is licensed to practice in Arkansas (license number E-10741) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1689606287.

Contact Information

	Dr Glenn Richard Gourley, MD
	3001 Broadway St Ne Ste 500, Minneapolis, MN 55413-2197
	(612) 871-1145
	(612) 870-5491

Map and Direction

Physician's Profile

Full Name	Dr Glenn Richard Gourley
Gender	Male
Speciality	Pediatrics - Pediatric Gastroenterology
Location	3001 Broadway St Ne Ste 500, Minneapolis, Minnesota
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1689606287
Provider Enumeration Date: 07/06/2006
Last Update Date: 06/05/2019

Medicare PECOS Information:

PECOS PAC ID: 2769498526
Enrollment ID: I20060302000612

Medical Identifiers

Medical identifiers for Dr Glenn Richard Gourley such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1689606287	NPI	-	NPPES
29-00053	Other	MN	MEDICA PRIMARY
1046326	Other	MN	PREFERRED ONE
1511089	Medicaid	IA
730T5GO	Other	MN	BCBS
182562	Other	MN	UCARE
29-00477	Other	MN	MEDICA CHOICE
29-00053	Other	MN	MEDICA CHOICE
220820200	Medicaid	MN

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
208000000X	Pediatrics	48367 (Minnesota)	Secondary
2080P0206X	Pediatrics - Pediatric Gastroenterology	48367 (Minnesota)	Secondary
2080P0206X	Pediatrics - Pediatric Gastroenterology	E-10741 (Arkansas)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Glenn Richard Gourley allows following entities to bill medicare on his behalf.

Entity Name	Mankato Clinic Ltd
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1629044029 PECOS PAC ID: 5597677955 Enrollment ID: O20031104000231

Entity Name	Fairview Health Services
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1013994359 PECOS PAC ID: 1951213057 Enrollment ID: O20031105000461

Entity Name	Mngi Digestive Health Pa
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1609804541 PECOS PAC ID: 8123016557 Enrollment ID: O20040504001467

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 Richard Gourley 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 Richard Gourley, MD Po Box 14909, Minneapolis, MN 55414-0909 Ph: (612) 871-1145	Dr Glenn Richard Gourley, MD 3001 Broadway St Ne Ste 500, Minneapolis, MN 55413-2197 Ph: (612) 871-1145

Reviews and Comments

Pediatrics Doctors in Minneapolis, MN

Dr. Kathleen F Sadak, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 2450 Riverside Ave, Minneapolis, MN 55454 Phone: 612-273-6402
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Anisha Rimal, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 715 S 8th St, Minneapolis, MN 55404 Phone: 612-873-6963
Dr. Marie Elizabeth Steiner, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: University Of Minnesota Physicians, 516 Delaware Street Se, Pwb Fourth Floor, Room 4-100, Minneapolis, MN 55455 Phone: 612-626-2916
Dr. Bruce Robert Blazar, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 516 Delaware Street Se, University Of Mn Physicians, Pwb Fifth Floor, Clinic 5b, Minneapolis, MN 55455 Phone: 612-273-2800
Dr. Pablo Ureta Avendano, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: University Of Minnesota Physicians, 516 Delaware Street Se, Pwb Fourth Floor, Room 4-100, Minneapolis, MN 55455 Phone: 612-626-2916
Dr. Diana B Cutts, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 715 S 8th St, Minneapolis, MN 55404 Phone: 612-873-6963

Dr Glenn Richard Gourley, MD - Medicare Pediatrics in Minneapolis, MN