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: July 26, 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
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

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

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

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.

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 11

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

Nurse Anesthetist, Certified Registered
3001 BROADWAY ST NE STE 500
MINNEAPOLIS, MN 55413
Nurse Practitioner
3001 BROADWAY ST NE STE 500
MINNEAPOLIS, MN 55413
Registered Nurse (Ambulatory Care)
3001 BROADWAY ST NE STE 500
MINNEAPOLIS, MN 55413
Registered Nurse (Gastroenterology)
3001 BROADWAY ST NE STE 500
MINNEAPOLIS, MN 55413
Registered Nurse
3001 BROADWAY ST NE STE 500
MINNEAPOLIS, MN 55413
Anesthesiology
3001 BROADWAY ST NE STE 500
MINNEAPOLIS, MN 55413
Nurse Anesthetist, Certified Registered
3001 BROADWAY ST NE STE 500
MINNEAPOLIS, MN 55413
Anesthesiology
3001 BROADWAY ST NE STE 500
MINNEAPOLIS, MN 55413

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.

What insurance does Glenn Gourley accept?

Health plans from Medica and 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 with the weekly NPPES data releases published by CMS.