NPIMap

Individual provider Active NPI

Mark Douglas Reida, MD

  • Internal Medicine Physician
  • Lincoln, NE
National Provider Identifier
1356354419
Registry record updated Mar 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
17748 Issued in NE
Practice address
3901 Pine Lake Rd
Suite 220
Lincoln, NE 68516-5497
Phone
(402) 421-3240
Fax
(402) 423-0739
NPI assigned
Aug 13, 2006
Last updated
Mar 2, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 17748 NE Primary

Addresses

Primary practice location

3901 Pine Lake Rd
Suite 220
Lincoln, NE 68516-5497

Mailing address

3901 Pine Lake Rd
Suite 220
Lincoln, NE 68516-5497
Phone (402) 421-3240

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mark.reida.1@14572.direct.athenahealth.com Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100420000531 NE Practitioner - Internal Medicine 1658422001 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Nebraska College of Medicine, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lincoln Internal Medicine Associates, PCGroup PAC ID 1658344825, 11 clinicians

Practice addresses (Care Compare)

3901 Pine Lake Rd
Suite 220
Lincoln, NE 68516-5497
Phone (402) 421-3240

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
17748NEMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lincoln Internal Medicine Associates, PC Internal Medicine CurrentSince Jul 1, 1997 Accepting new patients

Locations

3901 Pine Lake Rd
Ste 220
Lincoln, NE 68516
Phone (402) 421-3240

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14572/brand/3/csg/1/fhir/r4
  • Direct secure messaging: mark.reida.1@14572.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 12

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": "1155427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614643200000",
    "number": "1356354419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3901 PINE LAKE RD",
            "address_2": "SUITE 220",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685165497",
            "telephone_number": "402-421-3240",
            "fax_number": "402-423-0739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3901 PINE LAKE RD",
            "address_2": "SUITE 220",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685165497",
            "telephone_number": "402-421-3240",
            "fax_number": "402-423-0739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REIDA",
        "first_name": "MARK",
        "middle_name": "DOUGLAS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-13",
        "last_updated": "2021-03-02",
        "certification_date": "2021-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NE",
            "license": "17748",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mark.reida.1@14572.direct.athenahealth.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "3901 Pine Lake Rd",
            "address_2": "Suite 220",
            "city": "Lincoln",
            "state": "NE",
            "country_code": "US",
            "postal_code": "685165497",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lincoln, NE

Sources for this page

Verify at the official NPI Registry.