Individual provider Active NPI

Shaina L Reynolds, DO

  • Family Medicine Physician
  • Colorado Springs, CO
National Provider Identifier
1508823352
Registry record updated Aug 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
52872 Issued in CO
Practice address
4190 E Woodmen Rd
Suite 100
Colorado Springs, CO 80920-8075
Phone
(719) 632-4455
Fax
(719) 633-4613
NPI assigned
Apr 26, 2006
Last updated
Aug 15, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2013

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036108703 IL
Hospitalist Physician 208M00000X N1426 TX
Family Medicine Physician 207Q00000X N1426 TX
Family Medicine Physician 207Q00000X 52872 CO Primary

Addresses

Primary practice location

4190 E Woodmen Rd
Suite 100
Colorado Springs, CO 80920-8075

Mailing address

4190 E Woodmen Rd
Suite 100
Colorado Springs, CO 80920-8075
Phone (719) 632-4455

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 Osteopathy

State licenses

LicenseStateTypeSpecialty
N1426TXMDFamily Medicine Physician

NPI Registry JSON

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

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1376524800000",
    "number": "1508823352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4190 E WOODMEN RD",
            "address_2": "SUITE 100",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809208075",
            "telephone_number": "719-632-4455",
            "fax_number": "719-633-4613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4190 E WOODMEN RD",
            "address_2": "SUITE 100",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809208075",
            "telephone_number": "719-632-4455",
            "fax_number": "719-633-4613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "SHAINA",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-26",
        "last_updated": "2013-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036108703",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "TX",
            "license": "N1426",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "N1426",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "52872",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2013; 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.