Tatum J Reynolds, APN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209021803 Issued in IL

Practice address

1301 S Koke Mill Rd
Springfield, IL 62711-9252

Phone

(217) 547-9100

NPI assigned

Aug 11, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Tatum J Johnson Former name

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Orthopaedic Center of Illinois

  • Durable Medical Equipment & Medical Supplies
  • Springfield, IL
  • NPI 1144372798
  NPD (past)

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

{
    "created_epoch": "1597104000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651104000000",
    "number": "1992316376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 S KOKE MILL RD",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627119252",
            "telephone_number": "217-547-9100",
            "fax_number": "217-547-9236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 S KOKE MILL RD",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627119252",
            "telephone_number": "217-547-9100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3131 N Water St",
            "address_purpose": "LOCATION",
            "city": "Decatur",
            "state": "IL",
            "postal_code": "625262472",
            "country_code": "US",
            "telephone_number": "217-876-5320",
            "fax_number": "217-876-5865",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REYNOLDS",
        "first_name": "TATUM",
        "middle_name": "J",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-08-11",
        "last_updated": "2022-04-28",
        "certification_date": "2022-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209021803",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "APN LICENSE",
            "identifier": "209021803",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RN LICENSE",
            "identifier": "041402681",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TATUM",
            "last_name": "JOHNSON",
            "middle_name": "J",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• James R Reynolds, HIS
• Maren Leigh Reynolds, RN
• Megan Renee Reynolds
• Melanie R Reynolds, FNP
• Patricia Reynolds
• Patrick David Rhoades, MD
• Dorothy B Rhodes, LCPC
• Erica Rhodes
• Kristopher Rhodes
• Shanel Renee Rhodes, PA-C

• All providers in Springfield, IL
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2022; 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.