Individual provider Active NPI

Ethan Emerson Reynolds, M.D.

  • Anesthesiology Physician
  • Alton, IL
National Provider Identifier
1124339734
Registry record updated Aug 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
2010020282 Issued in MO
Practice address
1 Memorial Dr
Department of Anesthesiology
Alton, IL 62002-6722
Phone
(423) 620-9324
NPI assigned
Jun 29, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 2010020282 MO Primary
Anesthesiology Physician 207L00000X 036138391 IL

Addresses

Primary practice location

1 Memorial Dr
Department of Anesthesiology
Alton, IL 62002-6722

Mailing address

1 Memorial Dr
Alton, IL 62002-6722

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, MO2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20150716002284 IL Practitioner - AnesthesiologyPractitioner - Critical Care (Intensivists) 6103139399 Reassigns benefits to 1 organization
I20150717001008 MO Practitioner - AnesthesiologyPractitioner - Critical Care (Intensivists) 6103139399 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
AnesthesiologyAlso: Critical Care (Intensivists)
Education
University of Tennessee, HSC, College of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Midwest Anesthesia Providers SCGroup PAC ID 9830480581, 180 clinicians

Practice addresses (Care Compare)

1 Memorial Dr
Alton, IL 62002-6722
Phone (618) 463-7311

11133 Dunn Rd
Saint Louis, MO 63136-6163
Phone (314) 653-5000

Hospital & facility affiliations

  • Alton Memorial Hospital Hospital, Alton, IL, CCN 140002

Merit-based Incentive Payment System (MIPS)

Final score
92.71 of 100Reported as apm
Quality
82.25
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2010020282MOMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Midwest Anesthesia Providers S.C Anesthesiology CurrentSince Jun 1, 2016 Accepting new patients
Physician Specialists of St Lukes LLC CurrentSince Aug 5, 2018 Accepting new patients
Emergency Physicians of St. Luke'S, LLC Past Accepting new patients

Locations

1 Memorial Dr
Alton, IL 62002
Phone (618) 463-7240

2 Memorial Dr
Alton, IL 62002
Phone (618) 462-0710

11133 Dunn Rd
Saint Louis, MO 63136
Phone (314) 653-5000

2345 Dougherty Ferry Rd
Saint Louis, MO 63122
Phone (314) 821-5850

11133 Dunn Rd
Ste 108N
Saint Louis, MO 63136

10 Hospital Dr
Saint Peters, MO 63376
Phone (636) 394-2522

100 Entrance Way
Ofc
Saint Peters, MO 63376

232 S Woods Mill Rd
Town and Country, MO 63017
Phone (314) 205-6030

Interoperability endpoints

  • Direct secure messaging: ereynolds135531@direct.carenet.org

Organizations & group practices 3

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 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": "1277769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787011200000",
    "number": "1124339734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MEMORIAL DR",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620026722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEMORIAL DR",
            "address_2": "DEPARTMENT OF ANESTHESIOLOGY",
            "city": "ALTON",
            "state": "IL",
            "postal_code": "620026722",
            "telephone_number": "423-620-9324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "ETHAN",
        "middle_name": "EMERSON",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-29",
        "last_updated": "2026-08-18",
        "certification_date": "2026-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MO",
            "license": "2010020282",
            "primary": true
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IL",
            "license": "036138391",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alton, IL

Sources for this page

Verify at the official NPI Registry.