Roberto Reynoso, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA 19687 Issued in CA

Practice address

1630 E Herndon Ave
Fresno, CA 93720-3391

Phone

(559) 256-5200

Fax

(559) 256-5376

NPI assigned

Jul 11, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Permanente Medical Group IncGroup PAC ID 8921910225, 10,928 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: roberto.reynoso.p1@direct.spocortho.nextgenshare.com

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.

• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Santa Clara, CA
  • NPI 1073606299
  Medicare reassignment Care Compare group
• San Bernardino Medical Orthopaedic Group, Inc.

  • Orthopaedic Surgery Physician
  • Redlands, CA
  • NPI 1336187475
  Medicare reassignment NPD
• Sierra Pacific Orthopaedic Center Medical Group, Inc.

  • Specialist
  • Fresno, CA
  • NPI 1285669655
  Medicare reassignment NPD
• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Richmond, CA
  • NPI 1235226531
  NPD
• Permanente Medical Group, Inc

  • Clinical Medical Laboratory
  • San Jose, CA
  • NPI 1497971584
  NPD
• San Bernardino Medical Orthopaedic Group, Inc.

  • Orthopaedic Surgery Physician
  • Beaumont, CA
  • NPI 1235964537
  NPD

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

{
    "created_epoch": "1215734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641168000000",
    "number": "1679737381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1630 E HERNDON AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937203391",
            "telephone_number": "559-256-5200",
            "fax_number": "559-256-5376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1630 E HERNDON AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937203391",
            "telephone_number": "559-256-5200",
            "fax_number": "559-256-5376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOSO",
        "first_name": "ROBERTO",
        "name_prefix": "Mr.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-11",
        "last_updated": "2022-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA 19687",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "975 Sereno Dr",
            "city": "Vallejo",
            "state": "CA",
            "country_code": "US",
            "postal_code": "945892441",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Anacaren Reynosa Argueta
• Maria Victoria Reynosa, SUD REGISTERED
• Delisa Reynoso, COUNSELOR
• Joey Jesse Reynoso
• Monica Sandra Reynoso, M.S.
• Mohona Reza
• Mariam Rezai
• Sana Rezai, M.D.
• Parisa Rezapoor, MD
• Nader Magdy Rezkalla, MD

• Physician Assistant in Fresno, CA
• Providers in Fresno, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2022; 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.