Individual provider Active NPI

Adam William Reis, M.D.

  • Pediatrics Physician
  • Crestview Hills, KY
National Provider Identifier
1386058923
Registry record updated Mar 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
50458 Issued in KY
Practice address
334 Thomas More Pkwy
Crestview Hills, KY 41017-3464
Phone
(859) 341-3383
Fax
(859) 578-2013
NPI assigned
Jun 11, 2014
Last updated
Mar 10, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X LL37060 SC
Pediatrics Physician 208000000X 50458 KY Primary

Addresses

Primary practice location

334 Thomas More Pkwy
Crestview Hills, KY 41017-3464

Mailing address

PO Box 635283
Cincinnati, OH 45263-5283
Phone (859) 344-5555

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20170810002531 KY Practitioner - Pediatric Medicine 3971721002 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
LL37060SCMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Medical Group, Inc. CurrentSince Jul 31, 2017 Accepting new patients
Summit Medical Group, Inc Pediatrics CurrentSince Jul 31, 2017 Accepting new patients
St Elizabeth Medical Center, Inc Past Accepting new patients

Locations

334 Thomas More Pkwy
Crestview Hills, KY 41017
Phone (859) 331-6065

334 Thomas More Pkwy
Ste 200
Crestview Hills, KY 41017
Phone (859) 344-3737

830 Thomas More Pkwy
Ste 200A
Edgewood, KY 41017
Phone (859) 301-8686

830 Thomas More Pkwy
Fort Mitchell, KY 41017
Phone (859) 301-8686

300 Barnes Rd
Williamstown, KY 41097
Phone (859) 824-8217

Interoperability endpoints

  • Direct secure messaging: areis206301@direct-prd.stelizabeth.com

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1402444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615334400000",
    "number": "1386058923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 635283",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452635283",
            "telephone_number": "859-344-5555",
            "fax_number": "859-344-5554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "334 THOMAS MORE PKWY",
            "city": "CRESTVIEW HILLS",
            "state": "KY",
            "postal_code": "410173464",
            "telephone_number": "859-341-3383",
            "fax_number": "859-578-2013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REIS",
        "first_name": "ADAM",
        "middle_name": "WILLIAM",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-11",
        "last_updated": "2021-03-10",
        "certification_date": "2021-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "SC",
            "license": "LL37060",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "KY",
            "license": "50458",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crestview Hills, KY

Sources for this page

Verify at the official NPI Registry.