Jenese Nicole Reynolds-Gibbs, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4301096049 Issued in MI

Practice address

24911 Little Mack Ave
Suite C
Saint Clair Shores, MI 48080-3200

Phone

(586) 777-2050

NPI assigned

May 19, 2008

Last updated

Aug 18, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Wayne State University School of Medicine, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Henry Ford Health St. John HospitalGroup PAC ID 3173424082, 332 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Henry Ford Health St John Hospital Hospital, Detroit, MI, CCN 230165
• Henry Ford Health Hospital Hospital, Detroit, MI, CCN 230053

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jreynoldsgibbs1148986@direct.hfhs.org

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.

• Henry Ford Health St. John Hospital

  dba St John North Shores Hospital

  • Podiatrist
  • Harrison Township, MI
  • NPI 1043478910
  Medicare reassignment Care Compare group NPD
• Henry Ford Health St. John Hospital

  dba Henry Ford St John Hospital

  • Internal Medicine Physician
  • Detroit, MI
  • NPI 1912965088

  Family Medicine

  NPD
• Henry Ford Health St. John Hospital

  dba St John Hospital and Medical Center

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1023088168
  NPD
• McLaren Flint

  • General Practice Physician
  • Flint, MI
  • NPI 1275807372

  Family Medicine

  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Henry Ford Health System

  • General Acute Care Hospital
  • Detroit, MI
  • NPI 1134144801
  Care Compare affiliation
• Henry Ford Health St. John Hospital

  dba St John Hospital and Medical Center

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1023088168
  Care Compare affiliation

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

{
    "created_epoch": "1211155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1503014400000",
    "number": "1972760817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24911 LITTLE MACK AVE",
            "address_2": "SUITE C",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480803200",
            "telephone_number": "586-777-2050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24911 LITTLE MACK AVE",
            "address_2": "SUITE C",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480803200",
            "telephone_number": "586-777-2050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYNOLDS-GIBBS",
        "first_name": "JENESE",
        "middle_name": "NICOLE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-19",
        "last_updated": "2017-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "125-053484",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301096049",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS GROUP",
            "identifier": "0H208910",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eileen Margaret Reickert, MD
• David P. Renaud, D.D.S.
• Ashley Renock, LMSW
• Katerina Renusch
• Resilient Home Care Services LLC
• Madison Ricci
• Tamiko Rice, MSN, APRN, PMHNP-BC
• Richard C Mertz Jr MD PC (Metropolitan Eye Center and Outpatient Surgical Facility)
• Richard C Mertz Jr MD PC (Metropolitan Eye Center)
• Richard G. Raad DDS, PC

• Family Medicine Physician in Saint Clair Shores, MI
• Providers in Saint Clair Shores, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2017; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.