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DR. GLENN RICHARD GOURLEY M.D.
NPI 1689606287
Pediatrics - Pediatric Gastroenterology in Minneapolis, MN

Active since July 06, 2006PECOS Enrolled
3001 BROADWAY ST NE STE 500, MINNEAPOLIS, MN 55413(612) 871-1145(612) 870-5491 Get Directions Write a Review

NPPES record last updated: June 5, 2019. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jun 5, 2019, Mar 22, 2018, Oct 24, 2017 (3 updates tracked since 2017).

About Dr. Glenn Richard Gourley M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. GLENN RICHARD GOURLEY M.D. (NPI 1689606287) is an individual pediatric gastroenterology provider in Minneapolis, Minnesota, licensed in Arkansas (E-10741) and active in the NPI registry since July 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1689606287
Entity TypeIndividualMale
Primary Taxonomy2080P0206X
Provider Legal NameDR. GLENN RICHARD GOURLEYCredential: M.D.
Location Address3001 BROADWAY ST NE STE 500Minneapolis, MN 55413-2197
Mailing AddressPo Box 14909Minneapolis, MN 55414-0909 · (612) 871-1145 · Fax (612) 870-5491
Phone(612) 871-1145
Fax(612) 870-5491
Sole ProprietorNo
Enumeration DateJuly 6, 2006
Last NPPES UpdateJune 5, 20193 updates tracked since enumeration
✔ NPI 1689606287 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPediatrics · Pediatric GastroenterologyAllopathic & Osteopathic Physicians
Taxonomy Code2080P0206X
Licenses✔ Licensed in AR · E-10741✔ Licensed in MN · 48367
Definition
A pediatrician who specializes in the diagnosis and treatment of diseases of the digestive systems of infants, children and adolescents. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using lighted scopes to see internal organs.
Also ListedPediatricsTaxonomy 208000000X · License 48367 (MN)
3001 BROADWAY ST NE STE 500, Minneapolis, MN 55413
Open in Google Maps ↗

Other Identifiers 8

Other29-00477MN · Medica Choice
Other1046326MN · Preferred One
Other182562MN · Ucare
Other29-00053MN · Medica Primary
Other730T5GOMN · Bcbs
Medicaid1511089IA
Medicaid220820200MN
Other29-00053MN · Medica Choice

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Sanford Health Plan.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Glenn Richard Gourley M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

3

Medicare enrollment records show Glenn Gourley reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Mngi Digestive Health, P.A.
Same address
Gastroenterology
3001 BROADWAY ST NE STE 500
Minneapolis, MN 55413
  • Reassigned Medicare billing, Minnesota enrollment
  • Medicare enrollment name: Mngi Digestive Health PA
  • 322 clinicians in this Medicare group
NPI 1609804541 (612) 871-1145
Fairview Health Services
2.5 mi
General Acute Care Hospital
2450 RIVERSIDE AVE
Minneapolis, MN 55454
  • Reassigned Medicare billing, Minnesota enrollment
  • 4,038 clinicians in this Medicare group
NPI 1013994359 (612) 672-6000
Mankato Clinic Ltd
69 mi
Family Medicine
1230 E MAIN ST
Mankato, MN 56001
  • Reassigned Medicare billing, Minnesota enrollment
  • 322 clinicians in this Medicare group
NPI 1629044029 (800) 657-6944

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 55413 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$127.61 typical visit price
range $56.00 – $168.28
Typical copayment $31.90 (range $14.00 – $42.07)
Most-billed visit code 99204
Established Patient
$98.61 typical visit price
range $18.32 – $138.04
Typical copayment $24.65 (range $4.58 – $34.51)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 10

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

SHELBY MARIE WILLS
Nurse Practitioner
3001 BROADWAY ST NE STE 500
MINNEAPOLIS, MN 55413
Hennepin County (651) 871-1145
JANELLE LORRAINE GORG JOHNSON RN
Registered Nurse (Ambulatory Care)
3001 BROADWAY ST NE STE 500
MINNEAPOLIS, MN 55413
Hennepin County (612) 871-1145
SHELBY ADAMSON
Registered Nurse (Gastroenterology)
3001 BROADWAY ST NE STE 500
MINNEAPOLIS, MN 55413
Hennepin County (612) 871-1145
ANNA KOESTLER
Registered Nurse
3001 BROADWAY ST NE STE 500
MINNEAPOLIS, MN 55413
Hennepin County (612) 871-1145
DR. JENNIFER ELIZABETH BURKE M.D., M.P.H.
Anesthesiology
3001 BROADWAY ST NE STE 500
MINNEAPOLIS, MN 55413
Hennepin County (612) 870-5557
BETSY S ELLINGSON CRNA
Nurse Anesthetist, Certified Registered
3001 BROADWAY ST NE STE 500
MINNEAPOLIS, MN 55413
Hennepin County (128) 711-1456
DR. GREGORY SIMELGOR
Anesthesiology
3001 BROADWAY ST NE STE 500
MINNEAPOLIS, MN 55413
Hennepin County (612) 871-1145
MNGI DIGESTIVE HEALTH, P.A.
Internal Medicine (Gastroenterology)
3001 BROADWAY ST NE STE 500
MINNEAPOLIS, MN 55413
Hennepin County (612) 871-1145

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Glenn Gourley's NPI number?

The NPI number for Glenn Gourley is 1689606287. It was assigned to this individual provider in the NPPES registry on July 6, 2006.

Where is Glenn Gourley located?

Glenn Gourley practices at 3001 Broadway St NE Ste 500, Minneapolis, MN 55413. The listed phone number is (612) 871-1145.

What is Glenn Gourley's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Pediatric Gastroenterology, with taxonomy code 2080P0206X.

Is Glenn Gourley enrolled in Medicare?

Yes. Glenn Gourley is registered in the Medicare PECOS enrollment system.

Which organizations bill Medicare for Glenn Gourley's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Glenn Gourley reassigns Medicare benefits to 3 organizations: Mngi Digestive Health, P.A. (Minneapolis, MN), Fairview Health Services (Minneapolis, MN) and Mankato Clinic Ltd (Mankato, MN). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Glenn Gourley's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Glenn Gourley accept?

Health plans from Sanford Health Plan list Glenn Gourley as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Glenn Gourley was last updated on June 5, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.