1497740237 NPI number — BENEDICTO L REYES MD

Table of content: BENEDICTO L REYES MD (NPI 1497740237)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497740237 NPI number — BENEDICTO L REYES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REYES
Provider First Name:
BENEDICTO
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497740237
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9998 CROSSPOINT BLVD STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46256-3307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-579-2150
Provider Business Mailing Address Fax Number:
317-579-2130

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9998 CROSSPOINT BLVD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46256-3307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-579-2150
Provider Business Practice Location Address Fax Number:
317-579-2130
Provider Enumeration Date:
09/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  1043216 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X , with the licence number: 01043216A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 01043216A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 822400W . This is a "MEDICARE PTAN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: P00018311 . This is a "RR MEDICARE PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00018401 . This is a "RR MEDICARE PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00024405 . This is a "RR MEDICARE PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000109943 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 300109485 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: P00018314 . This is a "RR MEDICARE PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00018580 . This is a "RR MEDICARE PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 200142070A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00018312 . This is a "RR MEDICARE PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00023111 . This is a "RR MEDICARE PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00018308 . This is a "RR MEDICARE PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00018313 . This is a "RR MEDICARE PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00021420 . This is a "RR MEDICARE PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00018395 . This is a "RR MEDICARE PIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00018588 . This is a "RR MEDICARE PIN" identifier . This identifiers is of the category "OTHER".




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