NPIMap

Individual provider Active NPI

Jesus Bravo Reyna, NP

  • Family Nurse Practitioner
  • Burien, WA
National Provider Identifier
1528763596
Registry record updated Nov 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
AP61382433 Issued in WA
Practice address
14434 Ambaum Blvd SW Ste 5
Burien, WA 98166-1438
Phone
(206) 812-6140
Fax
(206) 812-2466
NPI assigned
Mar 31, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X AP61382433 WA Primary

Addresses

Primary practice location

14434 Ambaum Blvd SW Ste 5
Burien, WA 98166-1438

Mailing address

PO Box 34703
Seattle, WA 98124-1703

Other identifiers 1

IdentifierTypeStateIssuer
2249111MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA, TX2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230614002717 WA Practitioner - Nurse Practitioner 5799143350 Reassigns benefits to 1 organization
I20251028001020 TX Practitioner - Nurse Practitioner 5799143350 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sea Mar Community Health CentersGroup PAC ID 7315831161, shared by 37 NPIs, 235 clinicians
Pine Ridge Indian Health Service HospitalGroup PAC ID 4688571326, 107 clinicians

Practice addresses (Care Compare)

14434 Ambaum Blvd SW
Burien, WA 98166-1438
Phone (206) 812-6140

8720 14TH Ave S
Seattle, WA 98108-4807
Phone (206) 762-3730

East Hwy 18
Pine Ridge, SD 57770-1201
Phone (605) 867-3032

P O Box
Suite 1201
Pine Ridge, SD 57770-1201

P O Box 1201 E Hwy 18
Pine Ridge, SD 57770-1201

PO Box 1201 E Hwy 18
Pine Ridge, SD 57770-1201

Hospital & facility affiliations

  • Pine Ridge IHS Hospital Hospital, Pine Ridge, SD, CCN 430098
  • Monument Health Rapid City Hospital Hospital, Rapid City, SD, CCN 430077

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP61382433WAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Pine Ridge Indian Health Service Hospital CurrentSince Sep 25, 2025 Accepting new patients
Pine Ridge Indian Health Service Hospital CurrentSince Sep 25, 2025 Accepting new patients
Pine Ridge Indian Health Service Hospital Current Accepting new patients
Sea Mar Community Health Centers CurrentSince May 16, 2023 Accepting new patients
Sea Mar Community Health Centers Family Current Accepting new patients
Sea Mar Community Health Centers CurrentSince May 16, 2023 Accepting new patients
Sea-Mar Community Health Center Past Accepting new patients

Locations

14434 Ambaum Blvd SW
Ste 5
Burien, WA 98166
Phone (206) 244-9482

8720 14th Ave S
Seattle, WA 98108
Phone (206) 762-3730

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 17

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1680220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700438400000",
    "number": "1528763596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 34703",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981241703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14434 AMBAUM BLVD SW STE 5",
            "city": "BURIEN",
            "state": "WA",
            "postal_code": "981661438",
            "telephone_number": "206-812-6140",
            "fax_number": "206-812-2466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNA",
        "first_name": "JESUS",
        "middle_name": "BRAVO",
        "name_prefix": "Mr.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-03-31",
        "last_updated": "2023-11-20",
        "certification_date": "2023-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "AP61382433",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2249111",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Burien, WA

Sources for this page

Verify at the official NPI Registry.