Jimmy A Reidt, DC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2861 Issued in WI

Practice address

17 5TH Ave
Shell Lake, WI 54871

Phone

(715) 468-2275

NPI assigned

Jan 23, 2007

Last updated

Jun 21, 2013By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Specialty

Chiropractic

Education

Northwestern College of Chiropractic, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Lakes Community Health Center IncGroup PAC ID 0840366654, 104 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• The Lakes Community Health Center, Inc

  dba NorthLakes Community Clinic

  • Federally Qualified Health Center (FQHC)
  • Iron River, WI
  • NPI 1811178825
  Medicare reassignment Care Compare group NPD
• Shell Lake Cumberland Chiropractic Clinics LLC

  • Chiropractor
  • Shell Lake, WI
  • NPI 1023786324
  NPD
• The Lakes Community Health Center, Inc

  dba NorthLakes Community Clinic

  • Federally Qualified Health Center (FQHC)
  • White Lake, WI
  • NPI 1679983423
  NPD
• The Lakes Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Lakewood, WI
  • NPI 1699778233
  NPD (past)

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1371772800000",
    "number": "1508910514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 637",
            "city": "SHELL LAKE",
            "state": "WI",
            "postal_code": "548710637",
            "telephone_number": "715-468-2275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 5TH AVE",
            "city": "SHELL LAKE",
            "state": "WI",
            "postal_code": "54871",
            "telephone_number": "715-468-2275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REIDT",
        "first_name": "JIMMY",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-23",
        "last_updated": "2013-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "2861",
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MN",
            "license": "3069",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38867700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wendy Muska
• Margaret Mary Mussfeldt, APNP
• Brian Nord
• Richard L Olson, CRNA
• Sara Haynes Olson, APRN
• Catherine F Reuter, MD
• Kayla Rinkel
• Emily Schoenecker
• School District of Shell Lake
• Andrew Schulz, QTT

• Chiropractor in Shell Lake, WI
• Providers in Shell Lake, WI by specialty
• Chiropractor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.