NPIMap

Individual provider Active NPI

Tony L. Reynolds, NP-C

  • Family Nurse Practitioner
  • Alturas, CA
National Provider Identifier
1124387568
Registry record updated Aug 31, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95004432 Issued in CA
Practice address
535 S Main St
Alturas, CA 96101-4114
Phone
(530) 233-2288
NPI assigned
May 4, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2016

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 1116552 AL
Family Nurse Practitioner 363LF0000X 95004432 CA Primary
Family Nurse Practitioner 363LF0000X 201509529NP-PP OR

Addresses

Primary practice location

535 S Main St
Alturas, CA 96101-4114

Mailing address

535 S Main St
Alturas, CA 96101-4114
Phone (530) 233-2288

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20170209000956 CA Practitioner - Nurse Practitioner 3971767252 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
University of Alabama School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Last Frontier Healthcare District 31 clinicians

Practice addresses (Care Compare)

1111 N Nagle St
Alturas, CA 96101-3840

120 S Main St
Alturas, CA 96101-4086
Phone (530) 233-7054

Hospital & facility affiliations

  • Modoc Medical Center Hospital, Alturas, CA, CCN 051330
  • Lake District Hospital Hospital, Lakeview, OR, CCN 381309
  • Sky Lakes Medical Center Hospital, Klamath Falls, OR, CCN 380050

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1116552ALMDFamily Nurse Practitioner
95004432CAMDFamily Nurse Practitioner
201509529NP-PPORMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Last Frontier Healthcare District CurrentSince Dec 1, 2022 Accepting new patients
Lake Health District Past Accepting new patients
Lake Health District PastSince Dec 16, 2020 Accepting new patients
Goose Lake Medical Services Inc PastSince Dec 21, 2025 Accepting new patients

Locations

120 S Main St
Ste A
Alturas, CA 96101
Phone (530) 233-7054

1111 N Nagle St
Alturas, CA 96101
Phone (530) 708-8800

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/91732642-b694-4776-bbd7-c7859cc968c4/
  • FHIR API: https://fhir-myrecord.cerner.com/r4/794039a8-89a5-42e7-a8af-b2a702849aea/

Organizations & group practices 8

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 5

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": "1336089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472601600000",
    "number": "1124387568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "535 S MAIN ST",
            "city": "ALTURAS",
            "state": "CA",
            "postal_code": "961014114",
            "telephone_number": "530-233-2288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "535 S MAIN ST",
            "city": "ALTURAS",
            "state": "CA",
            "postal_code": "961014114",
            "telephone_number": "530-233-2288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "TONY",
        "middle_name": "L.",
        "name_prefix": "Mr.",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-05-04",
        "last_updated": "2016-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AL",
            "license": "1116552",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95004432",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OR",
            "license": "201509529NP-PP",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alturas, CA

Sources for this page

Verify at the official NPI Registry.