Kerisimasi L Reynolds, D.O.

Primary specialty

Sports Medicine (Orthopaedic Surgery) PhysicianTaxonomy code 207XX0005X

License

20A13974 Issued in CA

Practice address

39180 Farwell Dr Ste 110
Fremont, CA 94538-1015

Phone

(510) 739-6520

Fax

(510) 739-6522

NPI assigned

Mar 30, 2010

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Orthopedic Surgery

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Orthopaedic Sports Specialists a Medical Corp.Group PAC ID 7113968181, 3 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

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 and National Provider Directory roles.

• Orthopaedic Sports Specialists a Medical Corp

  • Orthopaedic Surgery Physician
  • Fremont, CA
  • NPI 1447311253
  Medicare reassignment Care Compare group NPD
• Acute Care Surgery Medical Group, Inc.

  • Surgery Physician
  • Sacramento, CA
  • NPI 1700069549
  Medicare reassignment NPD
• Surgical Affiliates of California

  • Surgery Physician
  • Los Banos, CA
  • NPI 1932440781
  Medicare reassignment NPD
• County of Santa Clara

  • General Acute Care Hospital
  • San Jose, CA
  • NPI 1063406551
  NPD (past)
• El Camino Hospital

  • General Acute Care Hospital
  • Mountain View, CA
  • NPI 1093712374
  NPD (past)
• Sequoia Health Services

  • General Acute Care Hospital
  • Redwood City, CA
  • NPI 1235172057
  NPD (past)
• Washington Township Hospital District

  • General Acute Care Hospital
  • Fremont, CA
  • NPI 1154472058
  NPD (past)
• Acute Care Surgery Medical Group, Inc.

  • Surgery Physician
  • Westminster,, CO
  • NPI 1477239267
  NPD (past)

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

{
    "created_epoch": "1269907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567555200000",
    "number": "1518282920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39180 FARWELL DR STE 110",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945381015",
            "telephone_number": "510-739-6520",
            "fax_number": "510-739-6522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39180 FARWELL DR STE 110",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945381015",
            "telephone_number": "510-739-6520",
            "fax_number": "510-739-6522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "KERISIMASI",
        "middle_name": "L",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-03-30",
        "last_updated": "2019-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "CA",
            "license": "20A13974",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Sports Medicine (Orthopaedic Surgery) Physician in Fremont, CA
• Providers in Fremont, CA by specialty
• Sports Medicine (Orthopaedic Surgery) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.