Individual provider Active NPI

Matthew Thomas Reynolds, D.O.

  • Emergency Medicine Physician
  • Newark, NJ
National Provider Identifier
1366700122
Registry record updated Jun 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
266070 Issued in NY
Practice address
201 Lyons Ave
Newark, NJ 07112-2027
Phone
(973) 926-7000
NPI assigned
Apr 30, 2012
Last updated
Jun 21, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 25MB10056800 NJ
Emergency Medicine Physician 207P00000X 266070 NY Primary

Addresses

Primary practice location

201 Lyons Ave
Newark, NJ 07112-2027

Mailing address

9 Ebb Tide Landing
Poquoson, VA 23662
Phone (607) 972-7055

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20171220002241 VA Practitioner - Emergency Medicine 4486888559 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Lake Erie College of Osteopathic Medicine, Erie, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Riverside Physician Services IncGroup PAC ID 5092608448, 793 clinicians

Practice addresses (Care Compare)

1500 Commonwealth Ave
Williamsburg, VA 23185-5229
Phone (757) 585-2250

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.91 of 100Reported as apm
Quality
92.86
Promoting interoperability
94.93
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MB10056800NJMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Riverside Physician Services Inc CurrentSince Oct 1, 2017 Accepting new patients
Riverside Physician Services Inc Current Accepting new patients
Riverside Physician Services Inc Emergency Medicine CurrentSince Oct 1, 2017 Accepting new patients

Locations

1500 Commonwealth Ave
Williamsburg, VA 23185
Phone (757) 585-2200

Organizations & group practices 3

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 1

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": "1335744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1498003200000",
    "number": "1366700122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9 EBB TIDE LANDING",
            "city": "POQUOSON",
            "state": "VA",
            "postal_code": "23662",
            "telephone_number": "607-972-7055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 LYONS AVE",
            "city": "NEWARK",
            "state": "NJ",
            "postal_code": "071122027",
            "telephone_number": "973-926-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "MATTHEW",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-30",
        "last_updated": "2017-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NJ",
            "license": "25MB10056800",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NY",
            "license": "266070",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, NJ

Sources for this page

Verify at the official NPI Registry.