Michelle Reynolds, MD
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Tyler, MN
NPI 1669906053 · NPPES record last updated Oct 2, 2020
Key facts
- NPI
- 1669906053
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- Practice address
- 240 Willow St
Tyler, MN 56178-1201 - Phone
- (507) 247-5521
- NPI assigned
- Apr 12, 2017
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 9
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- West Virginia University School of Medicine, 2017
- Medicare assignment
- May accept Medicare assignment
- Group practices
- Avera Tyler
Practice addresses (Care Compare)
240 Willow St
Tyler, MN 56178-1201
Phone (507) 247-5521
Hospital & facility affiliations
- Avera Tyler Hospital
- Avera Marshall Regional Medical Ctr
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210125000422 | MN | Practitioner - Family Practice | 8123398807 | Reassigns benefits to 4 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 68255 | MN | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Avera Marshall | Current |
Accepting new patients | |
| Avera Marshall | Current | Accepting new patients | |
| Avera Tyler | Current |
Accepting new patients | |
| Avera Marshall | Current |
Accepting new patients | |
| Avera Tyler | Current | Accepting new patients |
Locations
300 S Bruce St
Marshall, MN 56258
Phone (507) 532-9631
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 68255 | MN | |
| Student in an Organized Health Care Education/Training Program | 390200000X | Yes |
Addresses
Primary practice location
240 Willow St
Tyler, MN 56178-1201
Mailing address
240 Willow St
Tyler, MN 56178-1201
Other providers in Tyler, MN
- Lyon-Lincoln Electric Cooperative, Inc.
- Edward B Novak
- Enrico Ocampo
- Amy Lea Reese
- Christopher Stephen Reynolds
- Southwest Family Chiropractic P.L.C.
- Thrifty Drug Stores Inc
- Tyler Family Dental PLLC
- Tyler Healthcare Center Dba Tyler Healthcare Pharmacy
- Marissa Rae Tyler
All providers in Tyler, MN · Student in an Organized Health Care Education/Training Program in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 2, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.