Individual provider Active NPI

Jessica Ann Reis, M.D.

  • Psychiatry Physician
  • Louisville, KY
National Provider Identifier
1053755926
Registry record updated Jan 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
036158440 Issued in IL
Practice address
401 E Chestnut St
Suite 610
Louisville, KY 40202-5700
Phone
(502) 588-4450
Fax
(502) 588-9539
NPI assigned
Apr 23, 2013
Last updated
Jan 27, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X TP844 KY
Psychiatry Physician 2084P0800X 036158440 IL Primary

Addresses

Primary practice location

401 E Chestnut St
Suite 610
Louisville, KY 40202-5700

Mailing address

401 E Chestnut St
Suite 600
Louisville, KY 40202-5700
Phone (502) 588-4425

Other identifiers 1

IdentifierTypeStateIssuer
1053755926MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY, IL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20160408001020 KY Practitioner - Psychiatry 5193023075 Reassigns benefits to 3 organizations
I20220316003158 IL Practitioner - Psychiatry 5193023075 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
University of Louisville School of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

330 SW Adams St
Peoria, IL 61602-1502
Phone (309) 655-2877

5607 Ridge Rd
Crestwood, KY 40014-9117
Phone (309) 308-9692

8600 State Route 91
Suite 130
Peoria, IL 61615-7829
Phone (309) 683-5050

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036158440ILMDPsychiatry Physician
TP844KYMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Louisville Physicians, Inc. CurrentSince Jul 8, 2017 Accepting new patients
University of Louisville Physicians, Inc. Current Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
University of Louisville Physicians, Inc. CurrentSince Jul 8, 2017 Accepting new patients
Osf Multi-Specialty Group CurrentSince Mar 7, 2022 Accepting new patients
University Psychiatric Foundation, Inc. Psychiatry Past Accepting new patients

Locations

7752 Solution Ctr
Chicago, IL 60677

1420 W Pioneer Pkwy
Peoria, IL 61615
Phone (309) 308-5195

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

401 E Chestnut St
Unit 600
Louisville, KY 40202
Phone (502) 588-4425

401 E Chestnut St
Unit 610
Louisville, KY 40202
Phone (502) 588-4450

571 S Floyd St
Louisville, KY 40202
Phone (502) 561-2700

Organizations & group practices 7

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1366675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643241600000",
    "number": "1053755926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 E CHESTNUT ST",
            "address_2": "SUITE 600",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402025700",
            "telephone_number": "502-588-4425",
            "fax_number": "502-588-4427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 E CHESTNUT ST",
            "address_2": "SUITE 610",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402025700",
            "telephone_number": "502-588-4450",
            "fax_number": "502-588-9539"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REIS",
        "first_name": "JESSICA",
        "middle_name": "ANN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-23",
        "last_updated": "2022-01-27",
        "certification_date": "2022-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "KY",
            "license": "TP844",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036158440",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1053755926",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.