Reid Physician Associates, Inc.
Organization Active NPI Rural Health Clinic/Center · Cambridge City, IN
NPI 1154324630 · NPPES record last updated Jun 9, 2020
Key facts
- NPI
- 1154324630
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- REID PHYSICIAN ASSOCIATES, INC.
- Practice address
- 1154 S State Road 1 Ste 1
Cambridge City, IN 47327-9472 - Phone
- (765) 478-6108
- Fax
- (765) 478-1243
- NPI assigned
- May 27, 2005
- Organization subpart
- No
Authorized official
- Name
- Craig C. Kinyon
- Title
- Ceo
- Phone
- (765) 935-8806
Owners & managing parties with NPI records 11
-
Samuel Iden, MD
-
John E McGinty IV, M.D.
-
Jordan D Raynor, M.D.
Owned or controlled facilities with NPI records 1
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 7
Corporate family (same tax ID) 9
Practitioners 427
-
Asad Abbas, DO
-
Allanna R. Abel, RD
-
Luther Bert Adair II, M.D.
-
Augustine Ajuogu, MD
-
Todor D Alexandrov, M.D.
-
Kendall Jo Alig, FNP-BC
-
Bonnie M. Allen, NP-C
-
Ahmed Amro, MD
-
Patrick R Anderson, M.D.
-
Brandon Scott Baker, DPM
-
Jennifer Bales, M.D.
-
Balakrishna Bangalore, M.D.
-
Jeffery Howard Baron, FNP
-
Brennan N. Barrett, NP-C
-
Bernole Valdez Batenga, M.D.
-
Rohit Bawa, MD
-
Rick L Beck, LCSW; LISWS
-
Catherine Rose Berry, NP-C
-
James R Bertsch, D.O.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 15D0700073 | Reid Primary & Specialty Care- | Certificate of waiver | Sep 9, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Rural health clinic certification: CCN 153896
- Legal name
- REID PHYSICIAN ASSOCIATES INC
- Doing business as
- REID PRIMARY & SPECIALTY CARE - CAMBRIDGE CITY
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jun 30, 2010
- Last certification
- Apr 22, 2025
- Ownership / control type
- 2B
- Most recent change of ownership
- Oct 28, 2013 (1 total)
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jul 1, 2008 in IN
- Enrollment address
- 1154 S State Road 1
Ste 1
Cambridge City, IN 47327-9513
All disclosed owners & managing parties 22
| Name | Role | Since | Share |
|---|---|---|---|
| Samuel W Iden |
Corporate Officer |
Jan 1, 2024 | |
| Brett Guiley |
Corporate Officer | Jan 1, 2024 | |
| Craig C Kinyon |
Corporate Officer |
Oct 1, 2008 | 100% |
| W-2 Managing Employee |
Oct 1, 2008 | 100% | |
| Operational/Managerial Control |
Oct 1, 2008 | 100% | |
| James Tanner |
Corporate Officer |
Jan 1, 2014 | |
| Morgan Howard |
Corporate Officer |
Jan 1, 2015 | |
| Annuradha Bhandari |
Corporate Officer |
Jan 1, 2024 | |
| Bonita Washington-Lacey |
Corporate Officer |
Jan 1, 2002 | |
| Thomas Hilkert |
Corporate Officer |
Jan 1, 2002 | |
| Paul Lingle |
Corporate Officer |
Jan 1, 1987 | |
| John Edward McGinty |
Corporate Officer |
Jan 1, 2020 | |
| Garry Kleer |
Corporate Officer |
Jan 1, 2024 | |
| Mark Harrington |
Corporate Officer |
Jan 1, 2012 | |
| Robin Henry |
Corporate Officer |
Jan 1, 2019 | |
| Reid Physician Associates Inc |
5% Or Greater Direct Ownership Interest | Oct 28, 2013 | 100% |
| Denise Retz |
Corporate Officer |
Jan 1, 2017 | |
| Kathryn Girten |
Corporate Officer |
Jan 1, 2016 | |
| Benjamin Wells |
Corporate Officer |
Jul 1, 2024 | |
| W-2 Managing Employee |
Jul 1, 2024 | ||
| Other |
Jul 1, 2024 | ||
| Brad Collins |
Corporate Officer |
Jan 1, 2024 | |
| Aleasia Stewart |
Corporate Officer | Jan 1, 2024 | |
| John Jones |
Corporate Officer |
Jan 1, 2024 | |
| John Henderson |
Corporate Officer |
Jan 1, 2021 | |
| Jordan D Raynor |
Corporate Officer |
Jan 1, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20131029001108 | IN | Part a Provider - Rural Health Clinic | 6406910769 |
1 other NPI on this enrollment Practice locations: Cambridge City, IN |
National Provider Directory
- Tax ID family
- Reid Physician Assoc Inc
Locations
1 E Church St
Cambridge Cty, IN 47327
Phone (317) 478-6108
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
1154 S State Road 1 Ste 1
Cambridge City, IN 47327-9472
Mailing address
1100 Reid Pkwy
Richmond, IN 47374-1157
Phone (765) 478-6108
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 15-3896 | Other | IN | OSCAR |
| 201210980 | Medicaid | IN |
Other names
- Cambridge City Family Medicine
- Reid Primary & Specialty Care - Cambridge City
Other providers in Cambridge City, IN
- Quad/Med, LLC
- Red Line Ambulance Services, Inc.
- Bradley L Redmond
- Reid Physician Associates Inc
- Reid Physician Associates Inc
- Roadrunner-Express
- Julie A. Robinson
- Alicia Schenkel
- Martha Ann Schmidt
- Brandi Suzanne Shiverdecker
All providers in Cambridge City, IN · Rural Health Clinic/Center in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 9, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.