NPIMap

Individual provider Active NPI

Taylor Lynn Reall, PA-C

  • Medical Physician Assistant
  • East Providence, RI
National Provider Identifier
1104560788
Registry record updated Apr 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
Practice address
450 Veterans Memorial Pkwy BLDG 6
East Providence, RI 02914-5300
Phone
(401) 435-5533
NPI assigned
Apr 21, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X Primary

Addresses

Primary practice location

450 Veterans Memorial Pkwy BLDG 6
East Providence, RI 02914-5300

Mailing address

500 Mendon Rd Unit 46
Cumberland, RI 02864-6234

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tbailey169936@direct.lifespan.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
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
I20220829002256 RI Practitioner - Physician Assistant 8426432279 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Coastal Medical Physicians IncGroup PAC ID 0345658316, 222 clinicians

Practice addresses (Care Compare)

450 Veterans Memorial Pkwy
East Providence, RI 02914-5300
Phone (401) 435-5533

900 Warren Ave
East Providence, RI 02914-1430

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Coastal Medical Physicians, Inc. CurrentSince Aug 1, 2022 Accepting new patients
Lifespan Corporation Current Accepting new patients
Coastal Medical, Inc. Past Accepting new patients

Locations

450 Veterans Memorial Pkwy
Bldg 6
East Providence, RI 02914
Phone (401) 435-5533

900 Warren Ave
Ste 401
East Providence, RI 02914
Phone (401) 330-2480

727 East Ave
Pawtucket, RI 02860
Phone (401) 724-6800

Interoperability endpoints

  • Direct secure messaging: treall169936@brownhealth.medalliesdirect.net
  • Direct secure messaging: tbailey169936@brownhealth.medalliesdirect.net

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 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": "1650499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712016000000",
    "number": "1104560788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 MENDON RD UNIT 46",
            "city": "CUMBERLAND",
            "state": "RI",
            "postal_code": "028646234"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 VETERANS MEMORIAL PKWY BLDG 6",
            "city": "EAST PROVIDENCE",
            "state": "RI",
            "postal_code": "029145300",
            "telephone_number": "401-435-5533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REALL",
        "first_name": "TAYLOR",
        "middle_name": "LYNN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-21",
        "last_updated": "2024-04-02",
        "certification_date": "2024-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tbailey169936@direct.lifespan.org",
            "affiliation": "N",
            "address_1": "450 Veterans Memorial Pkwy Bldg 6",
            "city": "East Providence",
            "state": "RI",
            "country_code": "US",
            "postal_code": "029145300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in East Providence, RI

Sources for this page

Verify at the official NPI Registry.