Todd Reyburn, MD

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

01048555A Issued in IN

Practice address

2008 W Boulevard
Kokomo, IN 46902-6079

Phone

(765) 454-9729

NPI assigned

Jul 8, 2005

Last updated

Jul 18, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IN

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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

• Medical Imaging Professionals

  • Diagnostic Radiology Physician
  • Kokomo, IN
  • NPI 1487706818
  NPD (past) Authorized official

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

{
    "created_epoch": "1120780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184716800000",
    "number": "1043218555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1644",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462061644",
            "telephone_number": "866-494-8258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2008 W BOULEVARD",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469026079",
            "telephone_number": "765-454-9729"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYBURN",
        "first_name": "TODD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-08",
        "last_updated": "2007-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IN",
            "license": "01048555A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS INDIVIDUAL PIN NO",
            "identifier": "000000363372",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00256219",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brewster Restauro, PT
• Restore Family Counseling, LLC
• Restored Life Health Network
• Restored Life Taxi
• Kayla Rexroad, NP
• Chyan Reyes
• Deana Reynolds, LMFT
• Kallie Reynolds
• Florence Reznik, MA CCC SLP
• Rhino Taxi Service Inc

• Diagnostic Radiology Physician in Kokomo, IN
• Providers in Kokomo, IN by specialty
• Diagnostic Radiology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.