Active NPI
Ronald S Reagin Sr., DPM
- Podiatrist
- Baxley, GA
National Provider Identifier
1104801265
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Podiatrist
- License
- 000613
- Practice address
- 656 A-B S Main St
Baxley, GA 31515 - Phone
- (912) 367-5281
- Fax
- (912) 367-5240
- NPI assigned
- Dec 13, 2005
- Last updated
- Oct 16, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | 000613 | GA | Primary |
Addresses
Primary practice location
656 A-B S Main St
Baxley, GA 31515
Mailing address
PO Box 708
656 A-B S Main St
Baxley, GA 31515-0708
Phone (912) 367-5281
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 48SCBCS | Other | GA | MEDICARE ID TYPE PODIATRY |
| 000415346A | Medicaid | GA | |
| 480007952 | Other | GA | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000613 | GA | MD | Occupational Therapist |
Organizations & group practices 1
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.
-
- Foot Surgery Podiatrist
- Baxley, GA
- NPI 1366627887
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1134432000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1192492800000",
"number": "1104801265",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 708",
"address_2": "656 A-B S MAIN ST",
"city": "BAXLEY",
"state": "GA",
"postal_code": "315150708",
"telephone_number": "912-367-5281",
"fax_number": "912-367-5240"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "656 A-B S MAIN ST",
"city": "BAXLEY",
"state": "GA",
"postal_code": "31515",
"telephone_number": "912-367-5281",
"fax_number": "912-367-5240"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REAGIN",
"first_name": "RONALD",
"middle_name": "S",
"name_prefix": "Dr.",
"name_suffix": "Sr.",
"credential": "DPM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-12-13",
"last_updated": "2007-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "",
"desc": "Podiatrist",
"state": "GA",
"license": "000613",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE ID TYPE PODIATRY",
"identifier": "48SCBCS",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000415346A",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "480007952",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Baxley, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.