HEALTHPORT P.A. (NPI# 1154577641) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1154577641 |
| Entity Type | Organization |
| Organization Name | HEALTHPORT P.A. |
| Other Organization Name | PAIN RECOVERY CENTER OF TYLER |
| Practice Address |
4295 Kinsey Dr Tyler TX 75703-1004 |
| Practice Telephone | 9035265000 |
| Practice Fax Number | 9035265006 |
| Mailing Telephone | 9035265000 |
| Mailing Fax Number | 9035265006 |
| Enumeration Date | 2008-08-15 |
| Last Update Date | 2013-01-07 |
| Authorized Official Name | DR. KENNETH FULTS (PRESIDENT) |
| Authorized Official Telephone | 9035265000 |
| Authorized Official Credential | D.O. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 111N00000X | Chiropractor | Chiropractic Providers | ||
| N | 208VP0014X |
Pain Medicine Specialization: Interventional Pain Medicine |
Allopathic & Osteopathic Physicians | ||
| Y | 2081P2900X |
Physical Medicine & Rehabilitation Specialization: Pain Medicine |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | BCBS | 0066SG | 01 |
| TX | 208679501 | 05 |
| Other Name | Type Code |
|---|---|
| PAIN RECOVERY CENTER OF TYLER | Doing Business As Name - Organization |
| Street Address |
4295 KINSEY DR |
| City | TYLER |
| State | TX |
| Zip Code | 75703-1004 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336146794 | Janine Coles Islam | Physical Medicine & Rehabilitation | 4295 Kinsey Dr, Tyler, TX 75703-1004 | 2005-06-30 |
| 1407922057 | Larry R Isbell | Chiropractor | 4295 Kinsey Dr, Tyler, TX 75703-1004 | 2006-11-27 |
| 1235205881 | Isbell Chiropractic | Chiropractor | 4295 Kinsey Dr, Tyler, TX 75703-1004 | 2006-11-27 |
| 1063588580 | Kenneth L Fults | Physical Medicine & Rehabilitation | 4295 Kinsey Dr, Tyler, TX 75703-1004 | 2006-11-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174155477 | Choice Supportive Care Team Inc. | Family Medicine | 4293 Kinsey Drive, Tyler, TX 75703 | 2020-02-05 |
| 1770052532 | Refinery Chiropractic LLC | Chiropractor | 16637 Old Jacksonville Hwy, Suite D, Tyler, TX 75703 | 2018-11-21 |
| 1215419353 | Deidre Lynn Fergason | Occupational Therapy Assistant | 3505 Old Jacksonville Hwy, Tyler, TX 75703 | 2018-09-05 |
| 1710473681 | Justin Taylor Ross | Dentist | 8938 S Broadway Ave Ste 380, Tyler, TX 75703 | 2018-07-03 |
| 1457843450 | Adam Tyler Barnes, Dds of Texas II, Pllc | Dentist | 8938 South Broadway, Ste 480, Tyler, TX 75703 | 2018-06-05 |
| 1083106462 | Integrity Health | Internal Medicine | 5605 Old Bullard Rd Ste B, Tyler, TX 75703 | 2018-06-01 |
| 1427572544 | Cody Wayne Graham | Pharmacist | 5415 S. Broadway Ave., Tyler, TX 75703 | 2017-07-31 |
| 1750805941 | Roger Bryan Chapman | Nurse Practitioner | 6115 New Copeland Rd, Tyler, TX 75703 | 2017-07-28 |
| 1427570084 | Darah Lynne Dahlem | Speech-Language Pathologist | 401 E. Front Street Ste 123, Tyler, TX 75703 | 2017-07-14 |
| 1194267468 | Herman Lester Hampton Jr. | Surgery | 5803 Regents Row, Tyler, TX 75703 | 2016-11-17 |
| Find all providers in zip 75703 | ||||
| Taxonomy Code | 2081P2900X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Physical Medicine & Rehabilitation |
| Specialization | Pain Medicine |
| A physician who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic or cancer pain in both hospital and ambulatory settings. Patient care needs may also be coordinated with other specialists. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source changed] Additional Resources: American Board of Physical Medicine and Rehabilitation, 2007. http://www.abpmr.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Physical Medicine and Rehabilitation. A subspecialty certificate was approved by the ABMS in 1999. ACGME Accredited Residency Program Requirements: Proposal under development. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114953767 | Carefirst Medical Associates and Pain Rehabilitation, Pa | Physical Medicine & Rehabilitation | 13027 State Highway 155 S, Tyler, TX 75703-6548 | 2006-06-24 |
| 1073653820 | Jonathan Blau Md Pa | Physical Medicine & Rehabilitation | 1814 Roseland Blvd, Suite 200, Tyler, TX 75701-4234 | 2007-02-08 |
| 1790883239 | Barbara Jean Sigal | Physical Medicine & Rehabilitation | 820 S Baxter Ave, Tyler, TX 75701-2225 | 2006-09-20 |
| 1942260567 | Jonathan Blau | Physical Medicine & Rehabilitation | 2737 S Broadway Ave, Tyler, TX 75701 | 2006-03-27 |
| 1831192277 | Scott Joseph Lamb | Physical Medicine & Rehabilitation | 700 Olympic Plaza Cir, Tyler, TX 75701-1951 | 2005-05-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093314700 | Texas P&a LLC | Physical Medicine & Rehabilitation | 400 S Zang Blvd Ste 1210, Dallas, TX 75208-6624 | 2020-10-23 |
| 1598300386 | Ppsm Pllc | Physical Medicine & Rehabilitation | 4126 Southwest Fwy Ste 1700, Houston, TX 77027-7317 | 2019-11-15 |
| 1942844634 | Bioprorestore LLC | Physical Medicine & Rehabilitation | 3275 College Park Dr, The Woodlands, TX 77384-4501 | 2019-11-05 |
| 1619511300 | South Garland Medical Pllc | Physical Medicine & Rehabilitation | 1301 Northwest Hwy Ste 209, Garland, TX 75041-5896 | 2019-11-05 |
| 1295389492 | Complete Pain Solutions | Physical Medicine & Rehabilitation | 1241 Campbell Rd, Houston, TX 77055-6453 | 2019-07-26 |
| 1063998706 | Advanced Rehab Medicine, Pllc | Physical Medicine & Rehabilitation | 9119 Hwy 6, Suite 230, #127, Missouri City, TX 77479 | 2018-07-16 |
| 1265922876 | Occmed Centers of El Paso, Pa | Physical Medicine & Rehabilitation | 311 Camino Estancias, El Paso, TX 79912-3424 | 2018-05-18 |
| 1710475801 | Performance Pain and Sports Medicine, Pllc | Physical Medicine & Rehabilitation | 4126 Southwest Fwy Ste 1300, Houston, TX 77027-7310 | 2018-04-25 |
| 1275037574 | Rdt Technologies LLC | Physical Medicine & Rehabilitation | 3701 S Cooper St Ste 161, Arlington, TX 76015-3466 | 2018-03-21 |
| 1437662145 | Dfw Pain Institute Pllc | Physical Medicine & Rehabilitation | 14908 Devonshire Ln, Frisco, TX 75035-0648 | 2017-11-16 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.