NPIMap

Individual provider Active NPI

Christopher Stephen Reynolds, M.D.

  • Family Medicine Physician
  • Tyler, MN
National Provider Identifier
1134563653
Registry record updated Oct 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
68049 Issued in MN
Practice address
240 Willow St
Tyler, MN 56178-1201
Phone
(507) 247-5591
NPI assigned
Apr 26, 2013
Last updated
Oct 13, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Family Medicine Physician 207Q00000X 26526 WV
Family Medicine Physician 207Q00000X 68049 MN Primary

Addresses

Primary practice location

240 Willow St
Tyler, MN 56178-1201

Mailing address

240 Willow St
Tyler, MN 56178-1201
Phone (507) 247-5591

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20210125000060 MN Practitioner - Family Practice 1759684368 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
West Virginia University School of Medicine, 2013
Medicare assignment
May accept Medicare assignment
Group practices
Tyler Medical Clinic IncGroup PAC ID 1557252533, 4 clinicians
Avera TylerGroup PAC ID 9638088537, 15 clinicians

Practice addresses (Care Compare)

109 E Benton St
Lake Benton, MN 56149-1309
Phone (507) 368-4323

109 E Lake Benton St
Lake Benton, MN 56149-1309
Phone (507) 368-4323

240 Willow St
Tyler, MN 56178-1201
Phone (507) 247-5521

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Avera Tyler CurrentSince Oct 1, 2020 Accepting new patients
Avera Marshall CurrentSince Jan 1, 2023 Accepting new patients
Avera Marshall CurrentSince Jan 1, 2023 Accepting new patients
Avera Tyler Current Accepting new patients
Avera Marshall Past Accepting new patients
West Virginia University Hospitals, Inc Past Accepting new patients
Avera Tyler Past Accepting new patients

Locations

300 S Bruce St
Marshall, MN 56258
Phone (507) 532-9631

Interoperability endpoints

  • Direct secure messaging: christopher.reynolds@avera.sdhealthlink.net

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Avera Sunrise ManorTyler, MN, CCN 245357 Skilled nursing facility Corporate Director
Operational/Managerial Control
Adp of the SNF		 Jul 1, 2023
Jul 1, 2023
Feb 12, 2026

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Avera Tyler

    dba Avera Sunrise Manor

    • Skilled Nursing Facility
    • Tyler, MN
    • NPI 1821042920

    Adp of the SNF, Corporate Director, Operational/Managerial Control

    CMS ownership

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1366934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602547200000",
    "number": "1134563653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 WILLOW ST",
            "city": "TYLER",
            "state": "MN",
            "postal_code": "561781201",
            "telephone_number": "507-247-5591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 WILLOW ST",
            "city": "TYLER",
            "state": "MN",
            "postal_code": "561781201",
            "telephone_number": "507-247-5591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "CHRISTOPHER",
        "middle_name": "STEPHEN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-26",
        "last_updated": "2020-10-13",
        "certification_date": "2020-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "26526",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "68049",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, MN

Sources for this page

Verify at the official NPI Registry.