Active NPI
Robert Eugene Reardon, PH.D
- Psychologist
- Euclid, OH
National Provider Identifier
1124004957
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 5001
- Practice address
- 18901 Lake Shore Blvd
Euclid, OH 44119-1078 - Phone
- (216) 531-9000
- Fax
- (216) 274-9629
- NPI assigned
- Dec 22, 2005
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 5001 | OH | Primary |
Addresses
Primary practice location
18901 Lake Shore Blvd
Euclid, OH 44119-1078
Mailing address
18901 Lake Shore Blvd
Euclid, OH 44119-1078
Phone (216) 531-9000
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 352766 | Other | OH | STAYWELL HEALTH/WELLCARE |
| 1535088 | Other | OH | UMWA |
| 000000123581 | Other | OH | ANTHEM BLUE SHIELD |
| 0233198 | Medicaid | OH | |
| 000000123581 | Other | OH | UNICARE |
Other names 1
- Dr. Gene Reardon
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
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135209600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1196640000000",
"number": "1124004957",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18901 LAKE SHORE BLVD",
"city": "EUCLID",
"state": "OH",
"postal_code": "441191078",
"telephone_number": "216-531-9000",
"fax_number": "216-274-9629"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18901 LAKE SHORE BLVD",
"city": "EUCLID",
"state": "OH",
"postal_code": "441191078",
"telephone_number": "216-531-9000",
"fax_number": "216-274-9629"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REARDON",
"first_name": "ROBERT",
"middle_name": "EUGENE",
"name_prefix": "Dr.",
"credential": "PH.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-12-22",
"last_updated": "2007-12-03",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "OH",
"license": "5001",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STAYWELL HEALTH/WELLCARE",
"identifier": "352766",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UMWA",
"identifier": "1535088",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BLUE SHIELD",
"identifier": "000000123581",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0233198",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNICARE",
"identifier": "000000123581",
"state": "OH"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "GENE",
"last_name": "REARDON",
"prefix": "DR.",
"credential": "PH.D.",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Euclid, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 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.