Individual provider Active NPI

Eleia Joyce Serrano Reyes, MD

  • Family Medicine Physician
  • Hamilton, OH
National Provider Identifier
1245293513
Registry record updated Apr 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35071040R Issued in OH
Practice address
9582 Princeton Glendale Rd
Hamilton, OH 45011-9709
Phone
(513) 346-5640
Fax
(513) 346-5644
NPI assigned
Apr 8, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 35071040R OH Primary

Addresses

Primary practice location

9582 Princeton Glendale Rd
Hamilton, OH 45011-9709

Mailing address

9582 Princeton Glendale Rd
Hamilton, OH 45011-9709
Phone (513) 346-5640

Other practice location 1

945 Deis Dr
Fairfield, OH 45014-8130
Phone (513) 858-2666

Other identifiers 1

IdentifierTypeStateIssuer
0282993MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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

Enrollment IDStateProvider typePAC IDDetails
I20051025000904 OH Practitioner - Family Practice 2668499070 Practice locations: Fairfield, OH

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35071040ROHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Health Physicians Cincinnati, LLC Family Medicine CurrentSince May 23, 2021 Accepting new patients
Mercy Health Physicians Cincinnati LLC CurrentSince May 23, 2021 Accepting new patients

Locations

2446 Kipling Ave
Cincinnati, OH 45239
Phone (513) 583-8500

9582 Princeton Glendale Rd
West Chester, OH 45011
Phone (513) 346-5640

Interoperability endpoints

  • Direct secure messaging: ereyes455211@direct.ketteringhealth.org

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1144454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617580800000",
    "number": "1245293513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9582 PRINCETON GLENDALE RD",
            "city": "HAMILTON",
            "state": "OH",
            "postal_code": "450119709",
            "telephone_number": "513-346-5640",
            "fax_number": "513-346-5644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9582 PRINCETON GLENDALE RD",
            "city": "HAMILTON",
            "state": "OH",
            "postal_code": "450119709",
            "telephone_number": "513-346-5640",
            "fax_number": "513-346-5644"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "945 Deis Dr",
            "address_purpose": "LOCATION",
            "city": "Fairfield",
            "state": "OH",
            "postal_code": "450148130",
            "country_code": "US",
            "telephone_number": "513-858-2666",
            "fax_number": "513-858-2685",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REYES",
        "first_name": "ELEIA JOYCE",
        "middle_name": "SERRANO",
        "name_prefix": "Miss",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-08",
        "last_updated": "2021-04-05",
        "certification_date": "2021-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35071040R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0282993",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hamilton, OH

Sources for this page

Verify at the official NPI Registry.