Individual provider Active NPI

Jo Marie R Reilly, M.D.

  • Family Medicine Physician
  • Los Angeles, CA
National Provider Identifier
1033163902
Registry record updated Oct 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A51016 Issued in CA
Practice address
1400 S Grand Ave
Ste 101
Los Angeles, CA 90015-3048
Phone
(213) 744-0801
Fax
(213) 741-1423
NPI assigned
May 22, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X CAA051016 CA
Family Medicine Physician 207Q00000X A51016 CA Primary

Addresses

Primary practice location

1400 S Grand Ave
Ste 101
Los Angeles, CA 90015-3048

Mailing address

PO Box 31309
Los Angeles, CA 90031-0309
Phone (213) 744-0801

Other identifiers 3

IdentifierTypeStateIssuer
00A510160OtherCABLUE SHIELD
00A510160MedicaidCA
P00197281OtherGAMEDICARE RAILROAD

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address jomarie.reilly.p1@direct.eisnerhealth.nextgenshare.com Health Information Exchange (HIE)
Direct Messaging Address jreilly@direct.usc.edu Direct USC CARE MEDICAL GROUP, INC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071030000484 CA Practitioner - Family Practice 6608963152 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A51016CAMDFamily Medicine Physician
CAA051016CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Usc Care Medical Group, Inc Family Medicine CurrentSince Apr 1, 2009 Accepting new patients
Usc Care Medical Group, Inc CurrentSince Apr 1, 2009 Accepting new patients
Usc Verdugo Hills Hospital, LLC Past Accepting new patients
Usc Family Medicine Inc. Family Medicine Past Accepting new patients
Glendale Adventist Medical Center Past Accepting new patients
Usc University Hospital, Inc. Past Accepting new patients
Usc Family Medicine Inc Family Medicine Past Accepting new patients
Keck Medical Center of Usc Past Accepting new patients
White Memorial Medical Center Past Accepting new patients

Locations

1000 S Fremont Ave
Unit 7
Alhambra, CA 91803
Phone (626) 457-4240

1520 San Pablo St
Ste 1300
Los Angeles, CA 90033
Phone (323) 442-5900

1520 San Pablo St
Los Angeles, CA 90033
Phone (323) 442-5849

1441 Eastlake Ave
#5409
Los Angeles, CA 90089
Phone (323) 865-0563

1510 San Pablo St
Ste 649
Los Angeles, CA 90033

1510 San Pablo St
Ste 104
Los Angeles, CA 90033
Phone (213) 342-5777

1400 S Grand Ave
Ste 101
Los Angeles, CA 90015
Phone (212) 744-0801

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • Direct secure messaging: jo.marie.reilly.1@28334.direct.athenahealth.com

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729987200000",
    "number": "1033163902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31309",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900310309",
            "telephone_number": "213-744-0801",
            "fax_number": "213-741-1423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 S GRAND AVE",
            "address_2": "STE 101",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900153048",
            "telephone_number": "213-744-0801",
            "fax_number": "213-741-1423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REILLY",
        "first_name": "JO MARIE",
        "middle_name": "R",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-22",
        "last_updated": "2024-10-27",
        "certification_date": "2024-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "CAA051016",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A51016",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "00A510160",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A510160",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00197281",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jomarie.reilly.p1@direct.eisnerhealth.nextgenshare.com",
            "affiliation": "N",
            "endpointDescription": "NextGenShare, Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1530 S Olive St",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900153023",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jreilly@direct.usc.edu",
            "affiliation": "Y",
            "affiliationName": "USC CARE MEDICAL GROUP, INC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1520 San Pablo St",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900335310",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.