Individual provider Active NPI

Irma Liezl Reyes, DO

  • Neurology with Special Qualifications in Child Neurology Physician
  • Dayton, OH
National Provider Identifier
1356617765
Registry record updated Oct 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology with Special Qualifications in Child Neurology PhysicianTaxonomy code 2084N0402X
License
34.013452 Issued in OH
Practice address
1 Childrens PLZ
Dayton, OH 45404
Phone
(937) 641-3000
NPI assigned
Mar 29, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology with Special Qualifications in Child Neurology Physician 2084N0402X 34.013452 OH Primary

Addresses

Primary practice location

1 Childrens PLZ
Dayton, OH 45404

Mailing address

PO Box 933432
Cleveland, OH 44193-0039
Phone (937) 641-3000

Other practice location 1

1644 N Limestone St
Springfield, OH 45503-2652
Phone (937) 641-4000

Other practice location 2

3333 W Tech Rd
Miamisburg, OH 45342-0955
Phone (937) 641-4000

Other practice location 3

967 Bellefontaine Ave
Lima, OH 45804-2888
Phone (937) 641-4000

Other identifiers 1

IdentifierTypeStateIssuer
0297669MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20190117002534 OH Practitioner - Neurology 6709122310 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Midwestern University, Chicago College of Osteopathic Med, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1 Childrens PLZ
Dayton, OH 45404-1873
Phone (937) 641-4000

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
34.013452OHMDNeurology with Special Qualifications in Child Neurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dayton Children's Specialty Physicians, Inc. CurrentSince Nov 22, 2018 Accepting new patients
Dayton Children's Specialty Physicians, Inc. CurrentSince Nov 22, 2018 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Dayton Children's Hospital Past Accepting new patients

Locations

1 Childrens Plz
Dayton, OH 45404
Phone (937) 641-3600

967 Bellefontaine Ave
Lima, OH 45804
Phone (419) 224-1330

3333 W Tech Rd
Miamisburg, OH 45342
Phone (937) 641-3400

Interoperability endpoints

  • Direct secure messaging: ireyes654961@direct.bsmhealth.org

Organizations & group practices 4

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": "1332979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697414400000",
    "number": "1356617765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 933432",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441930039",
            "telephone_number": "937-641-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 CHILDRENS PLZ",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "45404",
            "telephone_number": "937-641-3000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1644 N Limestone St",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "OH",
            "postal_code": "455032652",
            "country_code": "US",
            "telephone_number": "937-641-4000",
            "fax_number": "937-641-4500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3333 W Tech Rd",
            "address_purpose": "LOCATION",
            "city": "Miamisburg",
            "state": "OH",
            "postal_code": "453420955",
            "country_code": "US",
            "telephone_number": "937-641-4000",
            "fax_number": "937-641-4500",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "967 Bellefontaine Ave",
            "address_purpose": "LOCATION",
            "city": "Lima",
            "state": "OH",
            "postal_code": "458042888",
            "country_code": "US",
            "telephone_number": "937-641-4000",
            "fax_number": "937-641-4500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REYES",
        "first_name": "IRMA",
        "middle_name": "LIEZL",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-29",
        "last_updated": "2023-10-16",
        "certification_date": "2023-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0402X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology",
            "state": "OH",
            "license": "34.013452",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0297669",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dayton, OH

Sources for this page

Verify at the official NPI Registry.