Active NPI
Michael J Reyes, PA C
- Medical Physician Assistant
- Tishomingo, OK
National Provider Identifier
1801879838
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 1474
- Practice address
- 817 E 6TH St
Tishomingo, OK 73460-1800 - Phone
- (580) 371-2392
- NPI assigned
- Nov 23, 2005
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 1474 | OK | Primary |
Addresses
Primary practice location
817 E 6TH St
Tishomingo, OK 73460-1800
Mailing address
1334 N Lansing Ave
Tulsa, OK 74106-5907
Phone (918) 273-9911
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100768880F | Medicaid | OK | |
| 100768880I | Medicaid | OK | |
| 100768880J | Medicaid | OK | |
| 37-1803 | Other | OK | MEDICARE |
| 37-1832 | Other | OK | MEDICARE |
| 37-1834 | Other | OK | MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
817 E 6TH St
Chickasaw Nation Medical Center
Tishomingo, OK 73460-1800
Phone (580) 371-2392
Hospital & facility affiliations
- Chickasaw Nation Medical Center
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Chickasaw Nation Division of Health | Current | Accepting new patients | |
| Chickasaw Nation Division of Health Chickasaw Nation Medical Center | Past | Accepting new patients |
Locations
1921 Stonecipher Dr
Ada, OK 74820
Phone (580) 421-4570
1001 N Country Club Rd
Ada, OK 74820
Phone (580) 421-4570
2510 Chickasaw Blvd
Ardmore, OK 73401
Phone (580) 226-8181
1600 N Washington Ave
Durant, OK 74701
Phone (580) 740-0205
1438 Hardcastle Blvd
Purcell, OK 73080
Phone (405) 527-4700
817 E 6th St
Tishomingo, OK 73460
Phone (580) 371-2392
Interoperability endpoints
- mreyes23276@direct.chickasawnationhealth.net
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 and National Provider Directory roles.
-
- Home Health Agency
- Ada, OK
- NPI 1811739071
-
- Durable Medical Equipment & Medical Supplies
- Ada, OK
- NPI 1295399095
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Ada, OK
- NPI 1255364923
-
- Primary Care Clinic/Center
- Tishomingo, OK
- NPI 1649330242
Hospital
-
- Primary Care Clinic/Center
- Ada, OK
- NPI 1962563148
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132704000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1801879838",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1334 N LANSING AVE",
"city": "TULSA",
"state": "OK",
"postal_code": "741065907",
"telephone_number": "918-273-9911",
"fax_number": "918-273-9946"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "817 E 6TH ST",
"city": "TISHOMINGO",
"state": "OK",
"postal_code": "734601800",
"telephone_number": "580-371-2392"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REYES",
"first_name": "MICHAEL",
"middle_name": "J",
"credential": "PA C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-23",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "OK",
"license": "1474",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100768880F",
"state": "OK"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100768880I",
"state": "OK"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100768880J",
"state": "OK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "37-1803",
"state": "OK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "37-1832",
"state": "OK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "37-1834",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tishomingo, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.