NPIMap

Individual provider Active NPI

Wayne J Reynolds, D.O.

  • Family Medicine Physician
  • Gloucester, VA
National Provider Identifier
1851366173
Registry record updated Feb 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0102049941 Issued in VA
Practice address
5659 Parkway Dr
Ste 210
Gloucester, VA 23061-3792
Phone
(804) 210-1025
Fax
(804) 210-1029
NPI assigned
Feb 21, 2006
Last updated
Feb 1, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 0102049941 VA Primary

Addresses

Primary practice location

5659 Parkway Dr
Ste 210
Gloucester, VA 23061-3792

Mailing address

5659 Parkway Dr
Ste 210
Gloucester, VA 23061-3792
Phone (804) 210-1025

Other identifiers 3

IdentifierTypeStateIssuer
005630789MedicaidVA
005829275MedicaidVA
010118433MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20041120000170 VA Practitioner - Family Practice 6800789405 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of New England, College of Osteo Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Sentara Medical GroupGroup PAC ID 8921903923, 1,396 clinicians

Practice addresses (Care Compare)

5659 Pkwy Dr
Suite 210
Gloucester, VA 23061-3792
Phone (804) 210-1025

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Gloucester Mathews Care Clinic CurrentSince Jan 21, 2020 Accepting new patients
Sentara Medical Group Family Medicine CurrentSince Jan 1, 2005 Accepting new patients
Riverside Physician Services Inc Past Accepting new patients
Riverside Emergency Physicians LLP Past Accepting new patients
Virginia Emergency Physicians LLP Past Accepting new patients
Riverside Physician Services Inc Family Medicine Past Accepting new patients

Locations

5659 Parkway Dr
Ste 210
Gloucester, VA 23061
Phone (804) 210-1025

6031 Industrial Dr
Gloucester, VA 23061
Phone (804) 210-1368

850 Kempsville Rd
Norfolk, VA 23502
Phone (757) 261-0162

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/16026/brand/1/csg/1/fhir/r4
  • Direct secure messaging: wayne.reynolds.1@16026.direct.athenahealth.com
  • Direct secure messaging: wreynolds33628@direct.sentara.net

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 4

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": "1140480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1328054400000",
    "number": "1851366173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5659 PARKWAY DR",
            "address_2": "STE 210",
            "city": "GLOUCESTER",
            "state": "VA",
            "postal_code": "230613792",
            "telephone_number": "804-210-1025",
            "fax_number": "804-210-1029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5659 PARKWAY DR",
            "address_2": "STE 210",
            "city": "GLOUCESTER",
            "state": "VA",
            "postal_code": "230613792",
            "telephone_number": "804-210-1025",
            "fax_number": "804-210-1029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "WAYNE",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-21",
        "last_updated": "2012-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0102049941",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005630789",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005829275",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010118433",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gloucester, VA

Sources for this page

Verify at the official NPI Registry.