Individual provider Active NPI

Kelly Renee Reagan, N.P.

  • Women's Health Nurse Practitioner
  • Austin, TX
National Provider Identifier
1861695728
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Women's Health Nurse PractitionerTaxonomy code 363LW0102X
License
583325 Issued in TX
Practice address
1301 W 38TH St
Ste. 109
Austin, TX 78705-1000
Phone
(512) 533-4171
Fax
(512) 452-7947
NPI assigned
Jun 7, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Women's Health Nurse Practitioner 363LW0102X 583325 TX Primary

Addresses

Primary practice location

1301 W 38TH St
Ste. 109
Austin, TX 78705-1000

Mailing address

1301 W 38TH St
Ste. 109
Austin, TX 78705-1000
Phone (512) 533-4171

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220928000520 TX Practitioner - Nurse Practitioner 2860878931 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Aa OBGYN PLLCGroup PAC ID 6103079462, 38 clinicians

Practice addresses (Care Compare)

12200 Renfert Way
Suite 100
Austin, TX 78758-5614
Phone (512) 451-8211

Merit-based Incentive Payment System (MIPS)

Final score
82.65 of 100Reported as group
Quality
92.24
Promoting interoperability
100
Improvement activities
40
Cost
49.93

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
583325TXMDWomen's Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Aa OBGYN PLLC CurrentSince Aug 1, 2022 Accepting new patients

Locations

12200 Renfert Way
Ste 100
Austin, TX 78758
Phone (512) 451-8211

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1181174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1861695728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 W 38TH ST",
            "address_2": "STE. 109",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787051000",
            "telephone_number": "512-533-4171",
            "fax_number": "512-452-7947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 W 38TH ST",
            "address_2": "STE. 109",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787051000",
            "telephone_number": "512-533-4171",
            "fax_number": "512-452-7947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REAGAN",
        "first_name": "KELLY",
        "middle_name": "RENEE",
        "name_prefix": "Mrs.",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "TX",
            "license": "583325",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Austin, TX

Sources for this page

Verify at the official NPI Registry.