NPIMap

Individual provider Active NPI

Charles M Reynolds, M.D.

  • Emergency Medicine Physician
  • Boise, ID
National Provider Identifier
1073770400
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
MD178898 Issued in OR
Practice address
1055 N Curtis Rd
Boise, ID 83706-1309
Phone
(208) 367-2121
NPI assigned
May 22, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X MD2012-0479 NM
Emergency Medicine Physician 207P00000X 50485 CO
Emergency Medicine Physician 207P00000X M-12317 ID
Emergency Medicine Physician 207P00000X 148073 CA
Emergency Medicine Physician 207P00000X MD178898 OR Primary

Addresses

Primary practice location

1055 N Curtis Rd
Boise, ID 83706-1309

Mailing address

2100 Powell St
Ste 900
Emeryville, CA 94608-1844
Phone (510) 851-7423

Other identifiers 2

IdentifierTypeStateIssuer
022498OtherCOKAISER COMMERCIAL NUMBER
22057242MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID, OR2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20140623001711 ID Practitioner - Emergency Medicine 2062686702 Reassigns benefits to 2 organizations
I20160929001501 OR Practitioner - Emergency Medicine 2062686702 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cep America LLCGroup PAC ID 6608056171, shared by 18 NPIs, 995 clinicians

Practice addresses (Care Compare)

1055 N Curtis Rd
Boise, ID 83706-1309
Phone (208) 367-2121

1775 Thompson Rd
Coos Bay, OR 97420-2125
Phone (541) 269-8111

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
87.3 of 100Reported as group
Quality
70.94
Improvement activities
40
Cost
92.94

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
148073CAMDEmergency Medicine Physician
50485COMDEmergency Medicine Physician
MD2012-0479NMMDEmergency Medicine Physician
MD178898ORMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Teladoc Health Medical Group, P.a. CurrentSince Jan 12, 2021 Accepting new patients
Cep America LLC Emergency Medicine CurrentSince Aug 1, 2016 Accepting new patients
Cep America, LLC Emergency Medicine Current Accepting new patients
Cep America, LLC Emergency Medicine CurrentSince Aug 1, 2016 Accepting new patients
Cep America LLC Emergency Medicine CurrentSince Aug 23, 2016 Accepting new patients
Cep America LLC Emergency Medicine Current Accepting new patients
Healthfront PC Emergency Medicine Past Accepting new patients

Locations

2100 Powell St
Ste 900
Emeryville, CA 94608
Phone (510) 350-2777

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

1055 N Curtis Rd
Boise, ID 83706
Phone (208) 367-2152

323 E Riverside Dr
Eagle, ID 83616
Phone (208) 302-6000

4300 E Flamingo Ave
Nampa, ID 83687
Phone (208) 205-1000

1775 Thompson Rd
Coos Bay, OR 97420
Phone (541) 269-8090

351 SW 9th St
Ontario, OR 97914
Phone (541) 881-7000

2801 St Anthony Way
Pendleton, OR 97801
Phone (541) 276-5121

2700 NW Stewart Pkwy
Roseburg, OR 97471
Phone (541) 673-0611

1945 Lakepointe Dr
Lewisville, TX 75057
Phone (214) 302-5246

Interoperability endpoints

  • Direct secure messaging: creynolds145056@direct.trinity-health.org

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 and National Provider Directory roles.

Hospital & facility affiliations 8

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": "1211414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1073770400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 POWELL ST",
            "address_2": "STE 900",
            "city": "EMERYVILLE",
            "state": "CA",
            "postal_code": "946081844",
            "telephone_number": "510-851-7423",
            "fax_number": "510-879-9120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 N CURTIS RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837061309",
            "telephone_number": "208-367-2121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "CHARLES",
        "middle_name": "M",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-22",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NM",
            "license": "MD2012-0479",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CO",
            "license": "50485",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "ID",
            "license": "M-12317",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "148073",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OR",
            "license": "MD178898",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KAISER COMMERCIAL NUMBER",
            "identifier": "022498",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "22057242",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

Verify at the official NPI Registry.