Active NPI
Jason Reagor
- Student in an Organized Health Care Education/Training Program
- Albuquerque, NM
National Provider Identifier
1164058772
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 2211 Lomas Blvd NE
Albuquerque, NM 87106-2719 - Phone
- (505) 603-0999
- NPI assigned
- Mar 14, 2020
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
2211 Lomas Blvd NE
Albuquerque, NM 87106-2719
Mailing address
500 Brighton Loop
Los Alamos, NM 87547-3573
Phone (505) 603-0999
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210630003991 | LA | Order and Referring Only - Vascular Surgery | 5698176402 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Interoperability endpoints
- jreagor4210071@direct.casso.us.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1584144000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1584144000000",
"number": "1164058772",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 BRIGHTON LOOP",
"city": "LOS ALAMOS",
"state": "NM",
"postal_code": "875473573",
"telephone_number": "505-603-0999"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2211 LOMAS BLVD NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871062719",
"telephone_number": "505-603-0999"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REAGOR",
"first_name": "JASON",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-03-14",
"last_updated": "2020-03-14",
"certification_date": "2020-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.