NPIMap

Individual provider Active NPI

Gary M Reagan, MD

  • Urology Physician
  • Mount Vernon, IL
National Provider Identifier
1417909060
Registry record updated Jul 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
036-064567 Issued in IL
Practice address
209 Crossroads PL
Suite 110
Mount Vernon, IL 62864-6254
Phone
(618) 244-6710
Fax
(618) 244-6779
NPI assigned
May 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2015

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 036-064567 IL Primary

Addresses

Primary practice location

209 Crossroads PL
Suite 110
Mount Vernon, IL 62864-6254

Mailing address

209 Crossroads PL 150
Mount Vernon, IL 62864-6546
Phone (618) 244-6710

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041006000192 IL Practitioner - Urology 9133188121 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Saint Louis University School of Medicine, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

209 Crossroads PL
Mount Vernon, IL 62864-6545
Phone (618) 244-1937

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
77.51 of 100Reported as group
Quality
49.04
Promoting interoperability
95
Improvement activities
40
Cost
69.42

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection20

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036-064567ILMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Deaconess Illinois Specialty Clinic, Inc. Urology Current Accepting new patients
Deaconess Illinois Specialty Clinic, Inc. CurrentSince Jan 14, 2023 Accepting new patients
Deaconess Illinois Specialty Clinic, Inc. CurrentSince Jan 14, 2023 Accepting new patients
Deaconess Illinois Clinic, Inc Past Accepting new patients

Locations

303 S Commercial St
Harrisburg, IL 62946
Phone (618) 767-6050

4113 S Water Tower Pl
Mount Vernon, IL 62864
Phone (618) 241-9071

209 Crossroads Pl
Ste 150
Mount Vernon, IL 62864
Phone (618) 244-6222

209 Crossroads Pl
Ste 110
Mount Vernon, IL 62864
Phone (618) 244-5053

209 Crossroads Pl
Mount Vernon, IL 62864
Phone (618) 242-4554

509 Hamacher St
Waterloo, IL 62298
Phone (618) 939-3939

Interoperability endpoints

  • Direct secure messaging: gary.reagan.1@27782.direct.athenahealth.com
  • Direct secure messaging: greagan@yourcarecommunity.org
  • Direct secure messaging: greagan419430@direct.deaconess.com

Organizations & group practices 4

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.

Hospital & facility affiliations 5

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": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437004800000",
    "number": "1417909060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 CROSSROADS PL 150",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646546",
            "telephone_number": "618-244-6710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 CROSSROADS PL",
            "address_2": "SUITE 110",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646254",
            "telephone_number": "618-244-6710",
            "fax_number": "618-244-6779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REAGAN",
        "first_name": "GARY",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-16",
        "last_updated": "2015-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "IL",
            "license": "036-064567",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Vernon, IL

Sources for this page

Verify at the official NPI Registry.