Active NPI
Kerry R Reynolds, PA-C
- Physician Assistant
- Ogden, UT
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 698 12TH St
Ogden, UT 84404-6200 - Phone
- (801) 475-3700
- Fax
- (801) 475-3701
- NPI assigned
- Oct 11, 2007
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | UT | Primary |
Addresses
Primary practice location
698 12TH St
Ogden, UT 84404-6200
Mailing address
PO Box 5546
Denver, CO 80217-5546
Phone (801) 475-3300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
5495 S 500
Suite 310
Ogden, UT 84405-7409
Phone (801) 475-3100
6112 S 1550
Ogden, UT 84405-5007
Phone (801) 475-3800
698 12TH St
Ogden, UT 84404-6200
Phone (801) 475-3700
Hospital & facility affiliations
- Community Nursing Services
- Atlas Home Care
- Intermountain Health McKay-Dee Hospital
- Ogden Regional Medical Center
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ogden Clinic Specialty Services LLC | Physician Assistant | Current | Accepting new patients |
Locations
1159 12th St
Ogden, UT 84404
Phone (801) 475-3700
4650 Harrison Blvd
Ogden, UT 84403
Phone (801) 475-3481
698 12th St
Ogden, UT 84404
Phone (801) 475-3700
5495 S 500 E
Ste 310
Ogden, UT 84405
Phone (801) 475-3100
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/JJJGBA
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.
-
- Family Medicine Physician
- Ogden, UT
- NPI 1578550083
-
- Sports Medicine (Family Medicine) Physician
- Ogden, UT
- NPI 1114203668
Physician Assistant
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Ogden, UT
- NPI 1720031636
-
- Home Health Agency
- West Valley City, UT
- NPI 1497703870
-
- General Acute Care Hospital
- Ogden, UT
- NPI 1194749580
-
- Home Health Agency
- Layton, UT
- NPI 1952417214
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1192060800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1620086400000",
"number": "1306034616",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5546",
"city": "DENVER",
"state": "CO",
"postal_code": "802175546",
"telephone_number": "801-475-3300",
"fax_number": "801-475-3301"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "698 12TH ST",
"city": "OGDEN",
"state": "UT",
"postal_code": "844046200",
"telephone_number": "801-475-3700",
"fax_number": "801-475-3701"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REYNOLDS",
"first_name": "KERRY",
"middle_name": "R",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-10-11",
"last_updated": "2021-05-04",
"certification_date": "2021-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "UT",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Ogden, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2021; 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.