Derek John Reynolds, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

F338090-1 Issued in NY

Practice address

Saint Regis Mohawk Tribe Health Services
404 State Route 37
Hogansburg, NY 13655-3109

Phone

(518) 358-3141

Fax

(518) 358-9175

NPI assigned

Jun 26, 2013

Last updated

Mar 30, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St Regis Mohawk TribeGroup PAC ID 5799748547, 11 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• The University of Vermont Health Network-Alice Hy Hospital, Malone, NY, CCN 331321
• SLHS Massena, Inc Hospital, Massena, NY, CCN 331322

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• St Regis Mohawk Tribe

  dba St Regis Mohawk Health Services

  • Federally Qualified Health Center (FQHC)
  • Akwesasne, NY
  • NPI 1457344558
  Medicare reassignment Care Compare group NPD
• Alice Hyde Medical Center

  • Critical Access Hospital
  • Malone, NY
  • NPI 1114954682
  Medicare reassignment NPD
• Alice Hyde Medical Center

  • General Practice Physician
  • Malone, NY
  • NPI 1568735660
  NPD
• St Regis Mohawk Tribe

  dba Partridge House

  • Substance Abuse Rehabilitation Facility
  • Akwesasne, NY
  • NPI 1659521052
  NPD (past)

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

• Alice Hyde Medical Center

  • Critical Access Hospital
  • Malone, NY
  • NPI 1114954682
  Care Compare affiliation
• Massena Hospital Inc

  • Critical Access Hospital
  • Massena, NY
  • NPI 1972604460
  Care Compare affiliation

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

{
    "created_epoch": "1372204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680134400000",
    "number": "1285074054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "SAINT REGIS MOHAWK TRIBE HEALTH SERVICES",
            "address_2": "404 STATE ROUTE 37",
            "city": "HOGANSBURG",
            "state": "NY",
            "postal_code": "136553109",
            "telephone_number": "518-358-3141",
            "fax_number": "518-358-9175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "SAINT REGIS MOHAWK TRIBE HEALTH SERVICES",
            "address_2": "404 STATE ROUTE 37",
            "city": "HOGANSBURG",
            "state": "NY",
            "postal_code": "136553109",
            "telephone_number": "518-358-3141",
            "fax_number": "518-358-9175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "DEREK",
        "middle_name": "JOHN",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-26",
        "last_updated": "2023-03-30",
        "certification_date": "2023-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NY",
            "license": "F338090-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03619812",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lacey S Peters, RN
• Phoenix Physical Therapy & Pta PLLC
• Heather Marie Pontius, R.D.
• Hillary Jill Pyke, O.D.
• Emmanuel Augusto Quinan, P.T.
• Saint Regis Mohawk Tribe (Saint Regis Mohawk Tribe diabetes Center)
• Rita Jean Saumier, RN
• Brenda Lyn Spurbeck, RNFP
• St Regis Mohawk Tribe (St Regis Mohawk Health Services)
• Connie M Thompson, CASAC-G

• Family Nurse Practitioner in Hogansburg, NY
• Providers in Hogansburg, NY by specialty
• Family Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2023; 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.