Individual provider Active NPI

Jennifer Connelly Reilly, WHNP

  • Obstetrics & Gynecology Nurse Practitioner
  • Richmond, VA
National Provider Identifier
1821327024
Registry record updated Jul 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology Nurse PractitionerTaxonomy code 363LX0001X
License
0024168547 Issued in VA
Practice address
5875 Bremo Rd Ste 701
Richmond, VA 23226-1928
Phone
(804) 523-2533
Fax
(804) 523-2534
NPI assigned
Dec 17, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Nurse Practitioner 363LX0001X 0024168547 VA Primary

Addresses

Primary practice location

5875 Bremo Rd Ste 701
Richmond, VA 23226-1928

Mailing address

2409 Narvik CT
Richmond, VA 23233-6611
Phone (804) 364-7293

Other identifiers 1

IdentifierTypeStateIssuer
VVP882AMedicaidVA

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20110114000601 VA Practitioner - Nurse Practitioner 3173712585 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Virginia Gynecologic Oncology LLCGroup PAC ID 4385662188, 7 clinicians

Practice addresses (Care Compare)

7607 Forest Ave
Suite 410
Richmond, VA 23229-4913
Phone (804) 200-7062

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0024168547VAMDObstetrics & Gynecology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Virginia Gynecologic Oncology LLC CurrentSince Oct 1, 2024 Accepting new patients
Commonwealth of Virginia State Board of Health Past Accepting new patients

Locations

2000 Health Park Dr
Brentwood, TN 37027
Phone (615) 372-5426

930 South Ave
Ste 4C
Colonial Heights, VA 23834
Phone (804) 410-9749

4701 Spotsylvania Pkwy
Ste 203
Fredericksburg, VA 22407
Phone (540) 834-5420

7611 Forest Ave
Ste 330
Richmond, VA 23229
Phone (804) 200-7025

7607 Forest Ave
Ste 410
Richmond, VA 23229

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1261008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594252800000",
    "number": "1821327024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2409 NARVIK CT",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232336611",
            "telephone_number": "804-364-7293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5875 BREMO RD STE 701",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232261928",
            "telephone_number": "804-523-2533",
            "fax_number": "804-523-2534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REILLY",
        "first_name": "JENNIFER",
        "middle_name": "CONNELLY",
        "credential": "WHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-12-17",
        "last_updated": "2020-07-09",
        "certification_date": "2020-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LX0001X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": "VA",
            "license": "0024168547",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "VVP882A",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Richmond, VA

Sources for this page

Verify at the official NPI Registry.