Individual provider Active NPI

Kevin John Reese, MD

  • Emergency Medicine Physician
  • Wilmington, NC
National Provider Identifier
1073518460
Registry record updated Oct 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
9701125 Issued in NC
Practice address
4402 Shipyard Blvd
Wilmington, NC 28403-6161
Phone
(910) 452-1400
Fax
(910) 791-9626
NPI assigned
Jun 14, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 9701125 NC Primary

Addresses

Primary practice location

4402 Shipyard Blvd
Wilmington, NC 28403-6161

Mailing address

4402 Shipyard Blvd
Wilmington, NC 28403-6161
Phone (910) 452-1400

Other identifiers 7

IdentifierTypeStateIssuer
B4556OtherNCMEDCOST
1073XOtherNCBCBS
891073XMedicaidNC
930084667OtherNCRAILROAD MEDICARE
01-28736OtherNCUNITED HEALTHCARE
930077045OtherNCRAILROAD MEDICARE
Q0112DMedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20071105000219 NC Practitioner - Emergency Medicine 5890882054 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Chicago College of Medicine and Surgery, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Medac Health Services PAGroup PAC ID 1254220809, 24 clinicians

Practice addresses (Care Compare)

4402 Shipyard Blvd
Wilmington, NC 28403-6161
Phone (910) 791-0075

Hospital & facility affiliations

  • Novant Health New Hanover Regional Medical Center Hospital, Wilmington, NC, CCN 340141
  • Pender Memorial Hospital Hospital, Burgaw, NC, CCN 341307

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9701125NCMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ecep II PA Emergency Medicine CurrentSince Jul 1, 1999 Accepting new patients
Ecep II PA Emergency Medicine CurrentSince Jul 1, 1999 Accepting new patients
Ecep II PA Emergency Medicine Current Accepting new patients

Locations

507 E Fremont St
Burgaw, NC 28425
Phone (910) 259-5451

2131 S 17th St
Wilmington, NC 28401
Phone (910) 342-3000

4402 Shipyard Blvd
Wilmington, NC 28403
Phone (910) 202-3363

151 Scotts Hill Medical Dr
Wilmington, NC 28411
Phone (910) 662-8440

5301 Wrightsville Ave
Wilmington, NC 28403
Phone (910) 452-8100

3710 Shipyard Blvd
Wilmington, NC 28403
Phone (910) 202-3363

Organizations & group practices 4

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.

Hospital & facility affiliations 3

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": "1118707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1286841600000",
    "number": "1073518460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4402 SHIPYARD BLVD",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284036161",
            "telephone_number": "910-452-1400",
            "fax_number": "910-791-9626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4402 SHIPYARD BLVD",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284036161",
            "telephone_number": "910-452-1400",
            "fax_number": "910-791-9626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REESE",
        "first_name": "KEVIN",
        "middle_name": "JOHN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-14",
        "last_updated": "2010-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NC",
            "license": "9701125",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "B4556",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1073X",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891073X",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "930084667",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "01-28736",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "930077045",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q0112D",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

Verify at the official NPI Registry.