Active NPI
Maura Reynolds
- Family Nurse Practitioner
- Willimantic, CT
National Provider Identifier
1760153993
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 10054
- Practice address
- 40 Mansfield Ave
Willimantic, CT 06226-2018 - Phone
- (860) 450-7471
- NPI assigned
- Sep 27, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 10054 | CT | Primary |
Addresses
Primary practice location
40 Mansfield Ave
Willimantic, CT 06226-2018
Mailing address
40 Mansfield Ave
Willimantic, CT 06226-2018
Phone (860) 450-7471
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20211109002392 | CT | Practitioner - Nurse Practitioner | 4284023482 |
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Generations Family Health Center Inc
Practice addresses (Care Compare)
40 Mansfield Ave
Willimantic, CT 06226-2018
Phone (860) 450-7471
Hospital & facility affiliations
- Hartford Healthcare at Home
- Windham Community Memorial Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10054 | CT | MD | General Practice Dentistry |
Hospital & facility affiliations 2
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Home Health Agency
- Wethersfield, CT
- NPI 1073529566
-
- General Acute Care Hospital
- Willimantic, CT
- NPI 1023191467
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1632700800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1632700800000",
"number": "1760153993",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "40 MANSFIELD AVE",
"city": "WILLIMANTIC",
"state": "CT",
"postal_code": "062262018",
"telephone_number": "860-450-7471"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "40 MANSFIELD AVE",
"city": "WILLIMANTIC",
"state": "CT",
"postal_code": "062262018",
"telephone_number": "860-450-7471"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REYNOLDS",
"first_name": "MAURA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-09-27",
"last_updated": "2021-09-27",
"certification_date": "2021-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "CT",
"license": "10054",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Willimantic, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2021; 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.