NPIMap

Individual provider Active NPI

Sean Peter Reynolds, PA-C

  • Physician Assistant
  • King, NC
National Provider Identifier
1427540780
Registry record updated Aug 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-08222 Issued in NC
Practice address
216 Moore Rd
King, NC 27021
Phone
(336) 983-4346
NPI assigned
Jun 3, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician Assistant 363A00000X 0010-08222 NC Primary

Addresses

Primary practice location

216 Moore Rd
King, NC 27021

Mailing address

PO Box 751803
Charlotte, NC 28275-1803

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address sreynolds288901@direct.novanthealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20180821001586 NC Practitioner - Physician Assistant 1355690504 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Forsyth Memorial Hospital IncGroup PAC ID 9537071790, 622 clinicians

Practice addresses (Care Compare)

216 Moore Rd
King, NC 27021-8703
Phone (336) 983-4346

6301 Stadium Dr
Clemmons, NC 27012-8766
Phone (336) 766-6473

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Forsyth Memorial Hospital, Inc. CurrentSince Jul 9, 2018 Accepting new patients
Novant Health Medical Group, LLC CurrentSince Jun 25, 2019 Accepting new patients
Novant Medical Group Inc CurrentSince Jun 25, 2019 Accepting new patients
Forsyth Memorial Hospital, Inc CurrentSince Jul 9, 2018 Accepting new patients
Forsyth Memorial Hospital, Inc Past Accepting new patients

Locations

10810 Mallard Creek Rd
Charlotte, NC 28262
Phone (704) 510-8000

6301 Stadium Dr
Clemmons, NC 27012
Phone (336) 766-6473

291 Broad St
Kernersville, NC 27284
Phone (336) 993-8181

216 Moore Rd
King, NC 27021
Phone (336) 768-1270

865 Westlake Dr
Mount Airy, NC 27030
Phone (336) 719-6100

5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441

100 Robinhood Medical Plz
Winston Salem, NC 27106
Phone (336) 718-0560

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

Interoperability endpoints

  • Direct secure messaging: sreynolds288901@direct.novanthealth.org

Organizations & group practices 7

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 1

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": "1527984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724198400000",
    "number": "1427540780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751803",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 MOORE RD",
            "city": "KING",
            "state": "NC",
            "postal_code": "27021",
            "telephone_number": "336-983-4346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "SEAN",
        "middle_name": "PETER",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-03",
        "last_updated": "2024-08-21",
        "certification_date": "2024-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-08222",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sreynolds288901@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "216 Moore Rd",
            "city": "King",
            "state": "NC",
            "country_code": "US",
            "postal_code": "27021",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in King, NC

Sources for this page

Verify at the official NPI Registry.