Active NPI
John P Reilly, MD
- Obstetrics & Gynecology Physician
- Grand Island, NE
National Provider Identifier
1942201629
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- 11469
- Practice address
- 2444 W Faidley Ave
Grand Island, NE 68803-4327 - Phone
- (308) 382-1100
- Fax
- (308) 385-0796
- NPI assigned
- Aug 3, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 11469 | NE | Primary |
Addresses
Primary practice location
2444 W Faidley Ave
Grand Island, NE 68803-4327
Mailing address
PO Box 550
Grand Island, NE 68802-0550
Phone (308) 382-1100
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10037720 | Other | NE | PALMETTO GBA |
| 47017633012 | Medicaid | NE | |
| 2902 | Other | NE | MIDLANDS CHOICE |
| 904 | Other | NE | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11469 | NE | MD | Obstetrics & Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grand Island Clinic Inc | Past | Accepting new patients |
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.
-
- Clinical Medical Laboratory
- Grand Island, NE
- NPI 1003061912
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1123027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1194220800000",
"number": "1942201629",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 550",
"city": "GRAND ISLAND",
"state": "NE",
"postal_code": "688020550",
"telephone_number": "308-382-1100",
"fax_number": "308-385-0796"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2444 W FAIDLEY AVE",
"city": "GRAND ISLAND",
"state": "NE",
"postal_code": "688034327",
"telephone_number": "308-382-1100",
"fax_number": "308-385-0796"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REILLY",
"first_name": "JOHN",
"middle_name": "P",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-03",
"last_updated": "2007-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "NE",
"license": "11469",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PALMETTO GBA",
"identifier": "10037720",
"state": "NE"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "47017633012",
"state": "NE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MIDLANDS CHOICE",
"identifier": "2902",
"state": "NE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "904",
"state": "NE"
}
],
"endpoints": [],
"other_names": []
}Other providers in Grand Island, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.