Dr Glenn Sample, PSYD - Medicare Counselor in Rockford, IL

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Dr Glenn Sample, PSYD is a medicare enrolled "Psychologist - Clinical" provider in Rockford, Illinois. 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 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 1881915270.

Contact Information

Dr Glenn Sample, PSYD
1643 N Alpine Rd Ste 104-609,
Rockford, IL 61107-1462
(773) 245-3449
Not Available

Map and Direction


Healthcare Provider's Profile

Full NameDr Glenn Sample
GenderMale
SpecialityPsychologist - Clinical
Location1643 N Alpine Rd Ste 104-609, Rockford, Illinois
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1881915270
  • Provider Enumeration Date: 06/20/2010
  • Last Update Date: 08/04/2021
  Medicare PECOS Information:
  • PECOS PAC ID: 4284993973
  • Enrollment ID: I20221012003125

Medical Identifiers

Medical identifiers for Dr Glenn Sample such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1881915270NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
101YP2500XCounselor - Professional 178010086 (Illinois)Secondary
101YP2500XCounselor - Professional 180010078 (Illinois)Secondary
103TC0700XPsychologist - Clinical 30340 (California)Secondary
103TC0700XPsychologist - Clinical 071009666 (Illinois)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 Sample allows following entities to bill medicare on his behalf.
Entity NameCarbon Health Primary Care Of California Pc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1972057990
PECOS PAC ID: 8628350626
Enrollment ID: O20170127001216
Entity NamePrairie Medical Associates
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1942973730
PECOS PAC ID: 5395142665
Enrollment ID: O20210929001750

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 AddressPractice 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

Reviews and Comments


Psychologist in Rockford, IL


Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.