Tyler Matthew Peckham

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

E.2505064 Issued in OH

Practice address

3359 Kemp Rd Ste 200
Beavercreek, OH 45431-2567

Phone

(937) 490-2090

Fax

(937) 490-2780

NPI assigned

Dec 22, 2017

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kettering Independent Medical Group IncGroup PAC ID 3173710936, 699 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.qualifacts.org/api/fhir/sbhihelp/r4/

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.

• Kettering Independent Medical Group Inc

  • Orthopaedic Surgery Physician
  • Miamisburg, OH
  • NPI 1629387865
  Medicare reassignment Care Compare group NPD
• Samaritan Behavioral Health, Inc.

  • Clinic/Center
  • Dayton, OH
  • NPI 1205888641
  Medicare reassignment NPD
• Samaritan Behavioral Health, Inc.

  • Community/Behavioral Health Agency
  • Dayton, OH
  • NPI 1235490939
  NPD
• Samaritan Behavioral Health, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Dayton, OH
  • NPI 1629022330
  NPD

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

{
    "created_epoch": "1513900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759449600000",
    "number": "1013423367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 W ROSS ST",
            "city": "TROY",
            "state": "OH",
            "postal_code": "453733931",
            "telephone_number": "937-216-9282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3359 KEMP RD STE 200",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "454312567",
            "telephone_number": "937-490-2090",
            "fax_number": "937-490-2780"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "303 W Ross St",
            "address_purpose": "LOCATION",
            "city": "Troy",
            "state": "OH",
            "postal_code": "453733931",
            "country_code": "US",
            "telephone_number": "937-216-9282",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PECKHAM",
        "first_name": "TYLER",
        "middle_name": "MATTHEW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-12-22",
        "last_updated": "2025-10-03",
        "certification_date": "2025-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "OH",
            "license": "E.2505064",
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tpeckham948476@direct.ketteringhealth.org",
            "affiliation": "N",
            "address_1": "3359 Kemp Rd Ste 200",
            "city": "Beavercreek",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454312567",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https:/khnarr.ketthealth.com/FHIR-PROD/api/FHIR/R4/",
            "affiliation": "N",
            "address_1": "3359 Kemp Rd Ste 200",
            "city": "Beavercreek",
            "state": "OH",
            "country_code": "US",
            "postal_code": "454312567",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jordan M Patak
• Ashish Patel, RPH
• Saraswati Somashekhar Patil, MD
• Ajai Paul
• Heather R Pavy
• Pediatric Associates of Dayton, Inc.
• Courtney Pemberton, APRN
• Jack R. Pence II, MD
• Natalie Pennyman, MSW,LISW-S
• Maureen Kennedy Perez, MD

• Mental Health Counselor in Beavercreek, OH
• Providers in Beavercreek, OH by specialty
• Mental Health Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2025; 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.