Individual provider Active NPI

Jennifer Butler Reynaldo, PA-C

  • Medical Physician Assistant
  • Virginia Beach, VA
National Provider Identifier
1891779468
Registry record updated Nov 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
0110001711 Issued in VA
Practice address
1120 First Colonial Rd
Suite 100
Virginia Beach, VA 23454-2418
Phone
(757) 481-2333
Fax
(757) 481-1037
NPI assigned
Dec 6, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2015

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA030295 DC
Physician Assistant 363A00000X 25MP00171700 NJ
Medical Physician Assistant 363AM0700X 0110001711 VA Primary

Addresses

Primary practice location

1120 First Colonial Rd
Suite 100
Virginia Beach, VA 23454-2418

Mailing address

1120 First Colonial Rd
Suite 100
Virginia Beach, VA 23454-2418
Phone (757) 481-2333

Other names 1

  • Jennifer J Butler Former name

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
I20161005001200 VA Practitioner - Physician Assistant 1052203890 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Eastern Virginia Medical School, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Privia Medical Group, LLCGroup PAC ID 4385682061, 1,522 clinicians

Practice addresses (Care Compare)

8644 Sudley Rd
Suite 220
Manassas, VA 20110-4425
Phone (571) 366-8845

950 N Glebe Rd
Suite 700
Arlington, VA 22203-4173

Hospital & facility affiliations

  • Sentara Home Care Services-Virginia Beach Home health agency, Chesapeake, VA, CCN 497747
  • Sentara Virginia Beach General Hospital Hospital, Virginia Beach, VA, CCN 490057
  • Sentara Princess Anne Hospital Hospital, Virginia Beach, VA, CCN 490119
  • Sentara Leigh Hospital Hospital, Norfolk, VA, CCN 490046

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MP00171700NJMDPhysician Assistant
0110001711VAMDMedical Physician Assistant
PA030295DCMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group, LLC CurrentSince Aug 25, 2016 Accepting new patients
Privia Medical Group, LLC CurrentSince Aug 25, 2016 Accepting new patients
Nova Physician Wellness Center PLLC Past Accepting new patients

Locations

8644 Sudley Rd
#220
Manassas, VA 20110

324 Louisa Ave
Ste 125
Virginia Beach, VA 23454
Phone (757) 351-6400

1120 First Colonial Rd
Ste 100
Virginia Beach, VA 23454
Phone (757) 481-2333

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/8042/brand/1/csg/1/fhir/r4
  • Direct secure messaging: jennifer.reynaldo.2@8042.direct.athenahealth.com

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 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": "1133827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447113600000",
    "number": "1891779468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 FIRST COLONIAL RD",
            "address_2": "SUITE 100",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234542418",
            "telephone_number": "757-481-2333",
            "fax_number": "757-481-1037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 FIRST COLONIAL RD",
            "address_2": "SUITE 100",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234542418",
            "telephone_number": "757-481-2333",
            "fax_number": "757-481-1037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNALDO",
        "first_name": "JENNIFER",
        "middle_name": "BUTLER",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-06",
        "last_updated": "2015-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "DC",
            "license": "PA030295",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00171700",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "VA",
            "license": "0110001711",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "BUTLER",
            "middle_name": "J",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Virginia Beach, VA

Sources for this page

Verify at the official NPI Registry.