Active NPI
Charles W Reynolds, M.D.
- Urology Physician
- Powell, TN
National Provider Identifier
1396745352
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- License
- MD0000014023
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3106070 | Other | TN | BLUE CROSS |
| 3001185 | Medicaid | TN | |
| 3106042 | Other | TN | BLUE CROSS |
| 1669416442 | Other | TN | GROUP NPI |
| CI2260 | Other | TN | RAILROAD 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
| License | State | Type | Specialty |
|---|---|---|---|
| MD0000014023 | TN | MD | Urology Physician |
| 14023 | TN | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Metro Knoxville Hma, LLC | Past | Accepting new patients |
Interoperability endpoints
- 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.
-
- Pharmacy
- Knoxville, TN
- NPI 1114990744
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.