Timothy B Vyrostek, DC CCSP

Primary specialty

Sports Physician ChiropractorTaxonomy code 111NS0005X

License

4038 Issued in PA

Practice address

10633 State Highway 18
Conneaut Lake, PA 16316-3225

Phone

(814) 382-1970

Fax

(814) 382-3619

NPI assigned

Aug 17, 2006

Sex

Male

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 3

Medicare fee-for-service enrollment

Enrolled in PA

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

ChiropracticAlso: Sports Medicine

Education

Palmer College Chiropractic - Davenport, 1997

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Lakeside Chiropractic PC

  • Chiropractor
  • Conneaut Lake, PA
  • NPI 1992713903
  Medicare reassignment NPD Authorized official
• Iadeluca Chiropractic Center Corry PC

  • Chiropractor
  • Corry, PA
  • NPI 1275115552
  NPD (past)
• Jack K. Vandervort

  • Chiropractor
  • Meadville, PA
  • NPI 1285696773
  NPD (past)

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683072000000",
    "number": "1003929308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10633 STATE HIGHWAY 18",
            "city": "CONNEAUT LAKE",
            "state": "PA",
            "postal_code": "163163225",
            "telephone_number": "814-382-1970",
            "fax_number": "814-382-3619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10633 STATE HIGHWAY 18",
            "city": "CONNEAUT LAKE",
            "state": "PA",
            "postal_code": "163163225",
            "telephone_number": "814-382-1970",
            "fax_number": "814-382-3619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VYROSTEK",
        "first_name": "TIMOTHY",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "DC CCSP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-17",
        "last_updated": "2023-05-03",
        "certification_date": "2023-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "PA",
            "license": "DC007097L",
            "primary": false
        },
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "PA",
            "license": "4038",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0016549110004",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "961159",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPMC",
            "identifier": "205055",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Thrift Drug Inc
• Thrive Pelvic Health and Wellness LLC
• Titusville Area Hospital
• Upmc Community Medicine
• Upmc Community Medicine Inc
• Dale R Weaver
• Leighanne Young, RPH
• Your Journey Therapy, LLC
• Amanda S Zarembinski, LPC

• Sports Physician Chiropractor in Conneaut Lake, PA
• Providers in Conneaut Lake, PA by specialty
• Sports Physician Chiropractor in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2023; 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.