Individual provider Active NPI

Reyna Silvia Aguilar-Martinez, APRN

  • Gerontology Nurse Practitioner
  • Liberal, KS
National Provider Identifier
1083244123
Registry record updated Jan 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
53-79082-062 Issued in KS
Practice address
102 E 11TH St
Liberal, KS 67901-2784
Phone
(620) 624-2565
Fax
(620) 624-3016
NPI assigned
Jan 16, 2020
Last updated
Jan 16, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X 53-79082-062 KS Primary

Addresses

Primary practice location

102 E 11TH St
Liberal, KS 67901-2784

Mailing address

102 E 11TH St
Liberal, KS 67901-2784
Phone (620) 624-2565

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220330002445 KS Practitioner - Nurse Practitioner 6800282807 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southwest Medical CenterGroup PAC ID 7517941651, 62 clinicians

Practice addresses (Care Compare)

555 W 15TH St
15TH Street Family Care Center
Liberal, KS 67901-2467
Phone (620) 624-0702

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.79 of 100Reported as group
Quality
68.45
Promoting interoperability
100
Improvement activities
40
Cost
72.27

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
53-79082-062KSMDGerontology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Southwest Medical Center CurrentSince Mar 1, 2022 Accepting new patients
Southwest Medical Center CurrentSince Mar 1, 2022 Accepting new patients
Southwest Family Medicine LLC CurrentSince Jan 19, 2020 Accepting new patients
Southwest Medical Center Past Accepting new patients
Taduran Sports Medicine and Osteopathic Wellness Center PastSince Jan 19, 2020 Accepting new patients

Locations

102 E 11th St
Liberal, KS 67901
Phone (620) 624-2565

2130 N Kansas Ave
Liberal, KS 67901
Phone (316) 626-5060

555 W 15th St
Liberal, KS 67901
Phone (620) 624-0702

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JGBGAA

Organizations & group practices 5

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 2

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": "1579132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579132800000",
    "number": "1083244123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 E 11TH ST",
            "city": "LIBERAL",
            "state": "KS",
            "postal_code": "679012784",
            "telephone_number": "620-624-2565",
            "fax_number": "620-624-3016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 E 11TH ST",
            "city": "LIBERAL",
            "state": "KS",
            "postal_code": "679012784",
            "telephone_number": "620-624-2565",
            "fax_number": "620-624-3016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGUILAR-MARTINEZ",
        "first_name": "REYNA",
        "middle_name": "SILVIA",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-16",
        "last_updated": "2020-01-16",
        "certification_date": "2020-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "KS",
            "license": "53-79082-062",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Liberal, KS

Sources for this page

Verify at the official NPI Registry.