NPIMap

Individual provider Active NPI

Timothy Neil Reid, MD

  • Family Medicine Physician
  • Carrollton, MO
National Provider Identifier
1811090780
Registry record updated Dec 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2005018441 Issued in MO
Practice address
1502 N Jefferson St
Carrollton, MO 64633-1948
Phone
(660) 542-1695
Fax
(660) 542-1944
NPI assigned
Sep 6, 2006
Last updated
Dec 5, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 2005018441 MO Primary
Sports Medicine (Family Medicine) Physician 207QS0010X 2005018441 MO

Addresses

Primary practice location

1502 N Jefferson St
Carrollton, MO 64633-1948

Mailing address

1502 N Jefferson St
Carrollton, MO 64633-1948
Phone (660) 542-1695

Other practice location 1

807 E Broadway St
Brunswick, MO 65236-1468
Phone (660) 548-2012

Other identifiers 1

IdentifierTypeStateIssuer
209427608MedicaidMO

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address CCMHHIMDept@ccmhospital.cernerdirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090824000191 MO Practitioner - Family PracticePractitioner - Emergency Medicine 0547314742 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Missouri, Columbia School of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carroll County Memorial HospitalGroup PAC ID 2860485638, 64 clinicians
Jefferson Medical GroupGroup PAC ID 6800894379, 10 clinicians

Practice addresses (Care Compare)

1502 N Jefferson St
Carrollton, MO 64633-1948
Phone (660) 542-1695

807 E Broadway St
Brunswick, MO 65236-1468
Phone (660) 548-2012

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
69.76 of 100Reported as group
Quality
46.12
Promoting interoperability
100
Improvement activities
40
Cost
53.08

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2005018441MOMDSports Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jefferson Medical Group Family Medicine CurrentSince Mar 8, 2014 Accepting new patients
Jefferson Medical Group Family Medicine Current Accepting new patients
Carroll County Memorial Hospital CurrentSince Aug 1, 2009 Accepting new patients
Ascentist Physicians Group, LLC Family Medicine PastSince Jul 27, 2009 Accepting new patients
Jefferson Medical Group Past Accepting new patients
United Investors LP Past Accepting new patients

Locations

807 E Broadway St
Brunswick, MO 65236
Phone (660) 542-1695

1502 N Jefferson St
Carrollton, MO 64633
Phone (660) 542-1695

Interoperability endpoints

  • Direct secure messaging: ccmhhimdept@ccmhospital.cernerdirect.com
  • Direct secure messaging: timothyreid@ccmhospital.cernerdirect.com

Ownership & related parties

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Carroll County Memorial HospitalCarrollton, MO, CCN 261332 Hospital Corporate Officer Jan 1, 2021
Carroll County Memorial HospitalCarrollton, MO, CCN 26Z332 Hospital Corporate Officer Jan 1, 2021
Jefferson Medical GroupCarrollton, MO, CCN 268666 Rural health clinic Corporate Officer Jan 1, 2021
Jefferson Medical Group Hale ClinicHale, MO, CCN 268665 Rural health clinic Corporate Officer Jan 1, 2021
Jefferson Medical GroupBrunswick, MO, CCN 268808 Rural health clinic Corporate Officer Jan 1, 2021

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 6

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.

Hospital & facility affiliations 16

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1157500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733356800000",
    "number": "1811090780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1502 N JEFFERSON ST",
            "city": "CARROLLTON",
            "state": "MO",
            "postal_code": "646331948",
            "telephone_number": "660-542-1695",
            "fax_number": "660-542-0363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1502 N JEFFERSON ST",
            "city": "CARROLLTON",
            "state": "MO",
            "postal_code": "646331948",
            "telephone_number": "660-542-1695",
            "fax_number": "660-542-1944"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "807 E Broadway St",
            "address_purpose": "LOCATION",
            "city": "Brunswick",
            "state": "MO",
            "postal_code": "652361468",
            "country_code": "US",
            "telephone_number": "660-548-2012",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REID",
        "first_name": "TIMOTHY",
        "middle_name": "NEIL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-06",
        "last_updated": "2024-12-05",
        "certification_date": "2024-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MO",
            "license": "2005018441",
            "primary": true
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "MO",
            "license": "2005018441",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "209427608",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "CCMHHIMDept@ccmhospital.cernerdirect.com",
            "affiliation": "N",
            "address_1": "1502 N Jefferson St",
            "city": "Carrollton",
            "state": "MO",
            "country_code": "US",
            "postal_code": "646331948",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Carrollton, MO

Sources for this page

Verify at the official NPI Registry.