NPIMap

Individual provider Active NPI

Angelo B Reyes, M.D.

  • Family Medicine Physician
  • Mount Pleasant, WI
National Provider Identifier
1073683470
Registry record updated Dec 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036096782 Issued in IL
Practice address
5801 Washington Ave
Ste 99
Mount Pleasant, WI 53406-4010
Phone
(913) 359-6001
Fax
(913) 359-5552
NPI assigned
Nov 9, 2006
Last updated
Dec 28, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 28, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036096782 IL Primary

Addresses

Primary practice location

5801 Washington Ave
Ste 99
Mount Pleasant, WI 53406-4010

Mailing address

601 E Main St Ste 101
Mahomet, IL 61853-7460
Phone (913) 359-6001

Other practice location 1

401 N York St Ste 4
Elmhurst, IL 60126-5510
Phone (630) 941-8190

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190418000771 WI Practitioner - Family Practice 3779546635 Practice locations: Mount Pleasant, WI; Waukesha, WI

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036096782ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
MBS Envision LLC CurrentSince Nov 1, 2020 Accepting new patients
F G Obregon & Associates SC Past Accepting new patients
TT Medical Group LLC Family Medicine Past Accepting new patients
Harris S Goldenberg, M.D., S.C. Past Accepting new patients
Fox Valley Physician Services SC Past Accepting new patients
Chicago Physicians Group LLC PastSince Oct 1, 2014 Accepting new patients
Functional Therapy Specialists PC Past Accepting new patients
Dysphagia Testing, LLC Past Accepting new patients
Stockholm Medical Company PastSince Jul 21, 2024 Accepting new patients
Integrated Audiology Care PC Past Accepting new patients
Interventional Pain Management, LTD. Past Accepting new patients
Stat Anesthesia Specialists, LTD. Past Accepting new patients
Czarnecki Chiropractic Center SC Past Accepting new patients

Locations

601 E Main St
Ste 101
Mahomet, IL 61853
Phone (913) 359-6001

Organizations & group practices 13

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.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609113600000",
    "number": "1073683470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 E MAIN ST STE 101",
            "city": "MAHOMET",
            "state": "IL",
            "postal_code": "618537460",
            "telephone_number": "913-359-6001",
            "fax_number": "913-359-5552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5801 WASHINGTON AVE",
            "address_2": "STE 99",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "534064010",
            "telephone_number": "913-359-6001",
            "fax_number": "913-359-5552"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "401 N York St Ste 4",
            "address_purpose": "LOCATION",
            "city": "Elmhurst",
            "state": "IL",
            "postal_code": "601265510",
            "country_code": "US",
            "telephone_number": "630-941-8190",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REYES",
        "first_name": "ANGELO",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-09",
        "last_updated": "2020-12-28",
        "certification_date": "2020-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036096782",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Pleasant, WI

Sources for this page

Verify at the official NPI Registry.