Individual provider Active NPI

Bernard Murty Reen III, MD

  • Interventional Cardiology Physician
  • Charlotte, NC
National Provider Identifier
1740288042
Registry record updated Jul 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
License
38416 Issued in NC
Practice address
125 Queens Rd Ste 200
Charlotte, NC 28204-3578
Phone
(704) 343-9800
Fax
(704) 347-2011
NPI assigned
Jul 11, 2005
Last updated
Jul 21, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 38416 NC
Interventional Cardiology Physician 207RI0011X 38416 NC Primary

Addresses

Primary practice location

125 Queens Rd Ste 200
Charlotte, NC 28204-3578

Mailing address

PO Box 60447
Charlotte, NC 28260-0447
Phone (704) 343-9800

Other practice location 1

1718 E 4th St
Ste 501
Charlotte, NC 28204-3260
Phone (704) 343-9800

Other identifiers 2

IdentifierTypeStateIssuer
8970798MedicaidNC
N38416MedicaidSC

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address breen34988@direct.novanthealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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

Enrollment IDStateProvider typePAC IDDetails
I20080311000682 NC Practitioner - Interventional CardiologyPractitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 9830274067 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Heart Care of Charlotte, LLC Cardiovascular Disease CurrentSince Feb 14, 2018 Accepting new patients
Hilton Head Heart PA Cardiovascular Disease Past Accepting new patients
The Presbyterian Hospital Past Accepting new patients

Locations

300 Billingsley Rd
Ste 101
Charlotte, NC 28211
Phone (704) 334-1401

6701 Carmel Rd
Unit 355
Charlotte, NC 28226
Phone (704) 334-1401

Interoperability endpoints

  • Direct secure messaging: breen34988@direct.novanthealth.org

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1121040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689897600000",
    "number": "1740288042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447",
            "telephone_number": "704-343-9800",
            "fax_number": "704-887-7570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 QUEENS RD STE 200",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282043578",
            "telephone_number": "704-343-9800",
            "fax_number": "704-347-2011"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1718 E 4th St",
            "address_2": "Ste 501",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282043260",
            "country_code": "US",
            "telephone_number": "704-343-9800",
            "fax_number": "704-887-7570",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REEN",
        "first_name": "BERNARD",
        "middle_name": "MURTY",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-11",
        "last_updated": "2023-07-21",
        "certification_date": "2023-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NC",
            "license": "38416",
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "NC",
            "license": "38416",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8970798",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "N38416",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "breen34988@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "1718 E 4th St",
            "address_2": "Ste 501",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "282043260",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.