Individual provider Active NPI

Kerry R Reynolds, PA-C

  • Physician Assistant
  • Ogden, UT
National Provider Identifier
1306034616
Registry record updated May 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
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

Updated by the provider on May 4, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130920000181 UT Practitioner - Physician Assistant 6406931245 Reassigns benefits to 1 organization

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
Ogden Clinic PCGroup PAC ID 9638078033, 104 clinicians

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 Home health agency, West Valley City, UT, CCN 467001
  • Atlas Home Care Home health agency, Layton, UT, CCN 467232
  • Intermountain Health McKay-Dee Hospital Hospital, Ogden, UT, CCN 460004
  • Ogden Regional Medical Center Hospital, Ogden, UT, CCN 460005

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew 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

  • FHIR API: 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.

Hospital & facility affiliations 4

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

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

Verify at the official NPI Registry.