Paul Thomas Reynolds, M.D.

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

74084 Issued in GA

Practice address

2400 Mount Zion Pkwy
Jonesboro, GA 30236

Phone

(615) 337-6920

NPI assigned

Apr 11, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in GA

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 1

Specialty

Gastroenterology

Education

University of Virginia School of Medicine, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Southeast Permanente Medical GroupGroup PAC ID 6204829013, 823 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Emory Decatur Hospital Hospital, Decatur, GA, CCN 110076

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• The Southeast Permanente Medical Group

  • Internal Medicine Physician
  • Atlanta, GA
  • NPI 1245266956

  Single Specialty

  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Dekalb Medical Center, Inc.

  dba Emory Decatur Hospital

  • General Acute Care Hospital
  • Decatur, GA
  • NPI 1093716979
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1334102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649808000000",
    "number": "1184980492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 MOUNT ZION PKWY",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "302362500",
            "telephone_number": "615-337-6920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 MOUNT ZION PKWY",
            "city": "JONESBORO",
            "state": "GA",
            "postal_code": "30236",
            "telephone_number": "615-337-6920"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1648 Pierce Dr Ste 327",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303220001",
            "country_code": "US",
            "telephone_number": "615-337-6920",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "PAUL",
        "middle_name": "THOMAS",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-04-11",
        "last_updated": "2022-04-13",
        "certification_date": "2022-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "GA",
            "license": "74084",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepiceast.kp.org:14430/Interconnect-prodgam/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "2400 Mount Zion Pkwy",
            "city": "Jonesboro",
            "state": "GA",
            "country_code": "US",
            "postal_code": "30236",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Relyon Labs Inc
• Renal Treatment Centers Mid Atlantic Inc (Jonesboro Dialysis)
• Residential Living, Inc
• Residential Living, Inc.
• Revive RX
• Camori Janae Rhodes, BCBA
• Raphel Rice
• Anna Richards
• Candace Roberts
• Lashanda Robertson, LPC

• Gastroenterology Physician in Jonesboro, GA
• Providers in Jonesboro, GA by specialty
• Gastroenterology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.