MIRA LUISE REYNOLDS MD
NPI 1699480335
Student in an Organized Health Care Education/Training Program in Portland, ME

Q: What is Mira Reynolds's NPI number?

The NPI number for Mira Reynolds is 1699480335. It was assigned to this individual provider in the NPPES registry on January 17, 2023.

Q: What is Mira Reynolds's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Q: When was this NPI record last updated?

The NPPES record for Mira Reynolds was last updated on March 25, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since January 17, 2023PECOS Enrolled

22 BRAMHALL ST, PORTLAND, ME 04102(207) 662-0111 Get Directions Write a Review

NPPES record last updated: March 25, 2025. Verified against the NPPES registry weekly; last sync: August 23, 2026.

Record update history: Mar 25, 2025, Jan 17, 2023 (2 updates tracked since 2023).

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About Mira Luise Reynolds Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MIRA LUISE REYNOLDS MD (NPI 1699480335) is an individual student in an organized health care education/training program in Portland, Maine and active in the NPI registry since January 2023. She is enrolled in Medicare PECOS and maintains a secondary practice location in Salt Lake City.

NPPES Registry Identity

NPI1699480335

Entity TypeIndividualFemale

Primary Taxonomy390200000X

Provider Legal NameMIRA LUISE REYNOLDSCredential: MD

Location Address22 BRAMHALL STPortland, ME 04102-3175

Mailing Address22 Bramhall StPortland, ME 04102-3175 · (207) 662-0111

Phone(207) 662-0111

Sole ProprietorNo

Enumeration DateJanuary 17, 2023

Last NPPES UpdateMarch 25, 20252 updates tracked since enumeration

NPPES CertifiedMarch 25, 2025

✔ NPI 1699480335 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

22 BRAMHALL ST, Portland, ME 04102

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Secondary Practice Location 1

Location 150 N Medical DrSalt Lake City, UT 84132-0001 · Phone (015) 812-1218

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mira Luise Reynolds Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ABBY LYNN LABRECQUE PA-C

Physician Assistant (Medical)