Active NPI
Matthew Reavis, RN
- Registered Nurse First Assistant
- Springfield, IL
National Provider Identifier
1295175115
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse First Assistant
- License
- 041.299217
- Practice address
- 1301 S Koke Mill Rd
Springfield, IL 62711-9252 - Phone
- (217) 547-9100
- Fax
- (217) 547-9236
- NPI assigned
- Jun 25, 2013
- 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 |
|---|---|---|---|---|
| Registered Nurse First Assistant | 163WR0006X | 041.299217 | IL | Primary |
Addresses
Primary practice location
1301 S Koke Mill Rd
Springfield, IL 62711-9252
Mailing address
1301 S Koke Mill Rd
Springfield, IL 62711-9252
Phone (217) 547-9100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 041.299217 | IL | MD | Registered Nurse First Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Orthopaedic Center of Il | Current | Accepting new patients |
Locations
1301 S Koke Mill Rd
Springfield, IL 62711
Phone (217) 547-9100
Interoperability endpoints
- matthewreavis@oci.allscriptsdirect.net
Organizations & group practices 1
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.
-
- Orthopaedic Surgery Physician
- Springfield, IL
- NPI 1154300572
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1372118400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1586736000000",
"number": "1295175115",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1301 S KOKE MILL RD",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627119252",
"telephone_number": "217-547-9100",
"fax_number": "217-547-9236"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1301 S KOKE MILL RD",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627119252",
"telephone_number": "217-547-9100",
"fax_number": "217-547-9236"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REAVIS",
"first_name": "MATTHEW",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-06-25",
"last_updated": "2020-04-13",
"certification_date": "2020-04-13",
"status": "A"
},
"taxonomies": [
{
"code": "163WR0006X",
"taxonomy_group": "",
"desc": "Registered Nurse, Registered Nurse First Assistant",
"state": "IL",
"license": "041.299217",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Springfield, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.