Individual provider Active NPI

Charles W Reynolds, M.D.

  • Urology Physician
  • Powell, TN
National Provider Identifier
1396745352
Registry record updated Dec 7, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
MD0000014023 Issued in TN
Practice address
7557 Dannaher LN
Suite 230
Powell, TN 37849-3558
Phone
(865) 637-9431
Fax
(865) 637-8887
NPI assigned
Jul 29, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X MD0000014023 TN Primary

Addresses

Primary practice location

7557 Dannaher LN
Suite 230
Powell, TN 37849-3558

Mailing address

9724 Kingston Pike
Suite 800
Knoxville, TN 37922-3347
Phone (865) 690-0602

Other identifiers 5

IdentifierTypeStateIssuer
3106070OtherTNBLUE CROSS
3001185MedicaidTN
3106042OtherTNBLUE CROSS
1669416442OtherTNGROUP NPI
CI2260OtherTNRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD0000014023TNMDUrology Physician
14023TNMDMassage Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Metro Knoxville Hma, LLC Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: creynolds@tua1320.srs-direct.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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1122595200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196985600000",
    "number": "1396745352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9724 KINGSTON PIKE",
            "address_2": "SUITE 800",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379223347",
            "telephone_number": "865-690-0602",
            "fax_number": "865-690-0515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7557 DANNAHER LN",
            "address_2": "SUITE 230",
            "city": "POWELL",
            "state": "TN",
            "postal_code": "378493558",
            "telephone_number": "865-637-9431",
            "fax_number": "865-637-8887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "CHARLES",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-29",
        "last_updated": "2007-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "TN",
            "license": "MD0000014023",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "3106070",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3001185",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "3106042",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1669416442",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CI2260",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Powell, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.