Reginald A Ebirim, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

68084 Issued in WI

Practice address

1405 Mill St
New London, WI 54961-2155

Phone

(920) 531-2000

Fax

(920) 531-2098

NPI assigned

Apr 27, 2006

Last updated

Mar 17, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IL

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

Specialty

Family PracticeAlso: Emergency Medicine, Internal Medicine, Obstetrics/Gynecology

Education

Illinois Medical College, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Rockford Health PhysiciansGroup PAC ID 2567374036, 520 clinicians

Lake Immediate Care and Clinic S CGroup PAC ID 4183881899, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Javon Bea Hospital Hospital, Rockford, IL, CCN 140239
• Northwestern Medicine McHenry Hospital, McHenry, IL, CCN 140116
• Advocate Good Shepherd Hospital Hospital, Barrington, IL, CCN 140291

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: rebirim59717@direct.mhemail.org
• Direct secure messaging: reginald.ebirim.1@12052.direct.athenahealth.com
• Direct secure messaging: reginald.ebirim.2@12052.direct.athenahealth.com

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.

• Rockford Health Physicians

  dba Mercyhealth Physicians

  • Multi-Specialty Clinic/Center
  • Rockford, IL
  • NPI 1043242886
  Medicare reassignment Care Compare group NPD
• Lake Immediate Care & Clinic S C

  • Internal Medicine Physician
  • Island Lake, IL
  • NPI 1114208642
  Medicare reassignment Care Compare group
• Goodhope Healthcare and Home Health Services Inc

  • Homemaker
  • McHenry, IL
  • NPI 1265724066
  NPD

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

• Advocate Health and Hospitals Corporation

  dba Advocate Good Shepherd Hospital

  • General Acute Care Hospital
  • Barrington, IL
  • NPI 1447368071
  Care Compare affiliation
• Javon Bea Hospital

  • General Acute Care Hospital
  • Rockford, IL
  • NPI 1629118609
  Care Compare affiliation
• Northern Illinois Medical Center

  dba Centegra Hospital McHenry

  • General Acute Care Hospital
  • McHenry, IL
  • NPI 1982611281
  Care Compare affiliation

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

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1396702957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2670 LAKE REUNION RD",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625218407",
            "telephone_number": "217-543-3869",
            "fax_number": "217-543-3651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1405 MILL ST",
            "city": "NEW LONDON",
            "state": "WI",
            "postal_code": "549612155",
            "telephone_number": "920-531-2000",
            "fax_number": "920-531-2098"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "650 W Columbia",
            "address_purpose": "LOCATION",
            "city": "Arthur",
            "state": "IL",
            "postal_code": "61911",
            "country_code": "US",
            "telephone_number": "217-543-3869",
            "fax_number": "217-543-3651",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EBIRIM",
        "first_name": "REGINALD",
        "middle_name": "A",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-27",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036113328",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "68084",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036113328-6",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036113328",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Traci Joy Diehl
• Terry J Dietrich, MD
• James Michael Doolin, RPH
• Payton L Dorn
• Amanda Kay Douma, APNP
• Lisa Ellickson-Albert, MA, BCBA
• Breana Leigh Fellinger, DO
• Michael Lynn Fetterolf, MD
• Jeffrey Allen Fillmore, APNP
• Julie A. Fischer, MSE, LPC, NCC

• Family Medicine Physician in New London, WI
• Providers in New London, WI by specialty
• Family Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.