Individual provider Active NPI

Emily Patrick Reavill, PA-C

  • Physician Assistant
  • Wilmington, NC
National Provider Identifier
1851729107
Registry record updated Nov 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
001005732 Issued in NC
Practice address
1202 Medical Center Dr
Attn: Credentialint
Wilmington, NC 28401-7307
Phone
(910) 341-3300
Fax
(910) 251-2067
NPI assigned
Oct 24, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 001005732 NC Primary
Medical Physician Assistant 363AM0700X

Addresses

Primary practice location

1202 Medical Center Dr
Attn: Credentialint
Wilmington, NC 28401-7307

Mailing address

1202 Medical Center Dr
Wilmington, NC 28401-7307
Phone (910) 341-3300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20150821014194 NC Practitioner - Physician Assistant 8325277866 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Medical University of South Carolina College of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wilmington Health PLLCGroup PAC ID 6103722509, 364 clinicians

Practice addresses (Care Compare)

1202 Medical Ctr Dr
Wilmington, NC 28401-7307
Phone (910) 341-1540

1222 Medical Ctr Dr
Wilmington, NC 28401-7307
Phone (910) 341-1540

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
001005732NCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Wilmington ASC LLC CurrentSince Jul 15, 2015 Accepting new patients
Wilmington Health PLLC CurrentSince Jul 15, 2015 Accepting new patients

Locations

1202 Medical Center Dr
Wilmington, NC 28401
Phone (910) 617-6705

Interoperability endpoints

  • Direct secure messaging: emily.patrick.p1@direct.wilmingtonhealth.nextgenshare.com

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1382572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479427200000",
    "number": "1851729107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1202 MEDICAL CENTER DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284017307",
            "telephone_number": "910-341-3300",
            "fax_number": "910-251-2067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1202 MEDICAL CENTER DR",
            "address_2": "ATTN: CREDENTIALINT",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284017307",
            "telephone_number": "910-341-3300",
            "fax_number": "910-251-2067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REAVILL",
        "first_name": "EMILY",
        "middle_name": "PATRICK",
        "name_prefix": "Miss",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-10-24",
        "last_updated": "2016-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "001005732",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

Verify at the official NPI Registry.