Individual provider Active NPI

Richard Charles Reno, M.D.

  • Pediatrics Physician
  • Destin, FL
National Provider Identifier
1295849438
Registry record updated Jun 20, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
ME79721 Issued in FL
Practice address
990 Airport Road
Pediatric Department
Destin, FL 32541
Phone
(850) 269-6400
Fax
(850) 654-9581
NPI assigned
Aug 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X ME79721 FL Primary

Addresses

Primary practice location

990 Airport Road
Pediatric Department
Destin, FL 32541

Mailing address

990 Airport Road
Pediatric Department
Destin, FL 32541
Phone (850) 269-6400

Other identifiers 2

IdentifierTypeStateIssuer
251905900MedicaidFL
58890OtherFLFLORIDA BLUE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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
I20111102000095 FL Practitioner - Pediatric Medicine 4981877263 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
Uniformed Services Uhs Fe Hebert School of Med, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
White-Wilson Medical Center PAGroup PAC ID 4082510607, 48 clinicians

Practice addresses (Care Compare)

990 Airport Rd
Destin, FL 32541-2820
Phone (850) 837-3848

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
White-Wilson Medical Center PA CurrentSince Nov 1, 2010 Accepting new patients

Locations

990 Airport Rd
Destin, FL 32541
Phone (850) 269-6400

1005 Mar Walt Dr
Ft Walton Bch, FL 32547
Phone (850) 863-8100

Interoperability endpoints

  • Direct secure messaging: richard.reno.1@21123.direct.athenahealth.com

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": "1155772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1371686400000",
    "number": "1295849438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "990 AIRPORT ROAD",
            "address_2": "PEDIATRIC DEPARTMENT",
            "city": "DESTIN",
            "state": "FL",
            "postal_code": "32541",
            "telephone_number": "850-269-6400",
            "fax_number": "850-654-9581"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "990 AIRPORT ROAD",
            "address_2": "PEDIATRIC DEPARTMENT",
            "city": "DESTIN",
            "state": "FL",
            "postal_code": "32541",
            "telephone_number": "850-269-6400",
            "fax_number": "850-654-9581"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RENO",
        "first_name": "RICHARD",
        "middle_name": "CHARLES",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-17",
        "last_updated": "2013-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME79721",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "251905900",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA BLUE",
            "identifier": "58890",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Destin, FL

Sources for this page

Verify at the official NPI Registry.