Active NPI
Shaina L Reynolds, DO
- Family Medicine Physician
- Colorado Springs, CO
National Provider Identifier
1508823352
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 52872
- 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
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00030453 | Other | IL | MEDICARE RAILROAD |
| 036108703 | Medicaid | IL |
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)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Osteopathy
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": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "P00030453",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036108703",
"state": "IL"
}
],
"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.