Jerry McReavy, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

953 Issued in CO

Practice address

500 N 5TH St
Hot Springs, SD 57747-1480

Phone

(605) 747-2000

NPI assigned

Oct 23, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SD

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Avera St Marys

  dba Avera St. Mary's Hospital

  • General Acute Care Hospital
  • Pierre, SD
  • NPI 1669457180
  Medicare reassignment
• Avera St Marys

  dba Avera St Marys Hospital ER CRNA

  • Emergency Medicine Physician
  • Pierre, SD
  • NPI 1073305496
  NPD

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

{
    "created_epoch": "1161561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1902989205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 236",
            "city": "HOT SPRINGS",
            "state": "SD",
            "postal_code": "577470236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 N 5TH ST",
            "city": "HOT SPRINGS",
            "state": "SD",
            "postal_code": "577471480",
            "telephone_number": "605-747-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCREAVY",
        "first_name": "JERRY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "953",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Claude William Massee, P.T.
• Anthony Stephen Mastroianni, MSW
• Peter Paul Mazzella Jr., LCSW-C
• Suzanne McEndree
• Kimberly Ann McNemar, MS, LPC-MH, QMHP
• Medicine Voice Healing Center
• Dennis Mensonides, R.R.T.
• Gary Lee Merkel, RKT
• Rebecca Sue Meyers, LPC-MH, QMHP, CADCII
• Theresa Michael, R.PH.

• Physician Assistant in Hot Springs, SD
• Providers in Hot Springs, SD by specialty
• Physician Assistant in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.