DR. GLENN SAMPLE PSY.D.
NPI 1881915270
Psychologist - Clinical in Rockford, IL

Q: What is Glenn Sample's NPI number?

The NPI number for Glenn Sample is 1881915270. It was assigned to this individual provider in the NPPES registry on June 20, 2010.

Q: What is Glenn Sample's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Q: When was this NPI record last updated?

The NPPES record for Glenn Sample was last updated on March 8, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 months 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.

Active since June 20, 2010PECOS Enrolled

1643 N ALPINE RD STE 104-609, ROCKFORD, IL 61107(773) 245-3449 Get Directions Write a Review

NPPES record last updated: March 8, 2026. Verified against the NPPES registry weekly; last sync: August 23, 2026.

Record update history: Mar 8, 2026, Aug 4, 2021, Jun 24, 2021 and 3 more (6 updates tracked since 2016).

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About Dr. Glenn Sample Psy.d. NPPES

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

DR. GLENN SAMPLE PSY.D. (NPI 1881915270) is an individual clinical provider in Rockford, Illinois, licensed in Illinois (071009666) and active in the NPI registry since June 2010. He is enrolled in Medicare PECOS and is a graduate of Other (2013).

NPPES Registry Identity

NPI1881915270

Entity TypeIndividualMale

Primary Taxonomy103TC0700X

Provider Legal NameDR. GLENN SAMPLECredential: PSY.D.

Location Address1643 N ALPINE RD STE 104-609Rockford, IL 61107-1462

Mailing Address1643 N Alpine Rd Ste 104-609Rockford, IL 61107-1462 · (773) 245-3449

Phone(773) 245-3449

Sole ProprietorYes

Medical School CMSOtherGraduated 2013

Enumeration DateJune 20, 2010

Last NPPES UpdateMarch 8, 20266 updates tracked since enumeration

NPPES CertifiedMarch 8, 2026

✔ NPI 1881915270 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

Licenses✔ Licensed in IL · 071009666✔ Licensed in CA · 30340

Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

Also ListedCounselor · ProfessionalTaxonomy 101YP2500X · License 178010086 (IL), 180010078 (IL)

1643 N ALPINE RD STE 104-609, Rockford, IL 61107

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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 Sample Psy.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID4284993973

PECOS Enrollment IDI20180126000958

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 61107 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

$168.44 typical visit price

range $54.80 – $168.44

Typical copayment $42.11 (range $13.70 – $42.11)

Most-billed visit code 99205

Established Patient

$97.25 typical visit price

range $17.16 – $136.56

Typical copayment $24.31 (range $4.29 – $34.14)

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.

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 Sample's NPI number?

The NPI number for Glenn Sample is 1881915270. It was assigned to this individual provider in the NPPES registry on June 20, 2010.

Where is Glenn Sample located?

Glenn Sample practices at 1643 N Alpine Rd Ste 104-609, Rockford, IL 61107. The listed phone number is (773) 245-3449.

What is Glenn Sample's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Is Glenn Sample enrolled in Medicare?

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

When was this NPI record last updated?

The NPPES record for Glenn Sample was last updated on March 8, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 months 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.