Tyler Pensis

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

5446-12 Issued in WI

Practice address

W5675 Cty Hwy B
Shawano, WI 54166

Phone

(715) 526-6158

NPI assigned

Apr 4, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Specialty

Chiropractic

Education

Northwestern College of Chiropractic, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Countryview Chiropractic Clinic SCGroup PAC ID 7810088333, 4 clinicians

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.

• Countryview Chiropractic Clinic, S.C.

  • Chiropractor
  • Shawano, WI
  • NPI 1316095185
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1554336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554336000000",
    "number": "1043772346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N4791 CAPITOL DR",
            "city": "SHAWANO",
            "state": "WI",
            "postal_code": "541666102",
            "telephone_number": "715-304-9645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W5675 CTY HWY B",
            "city": "SHAWANO",
            "state": "WI",
            "postal_code": "54166",
            "telephone_number": "715-526-6158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENSIS",
        "first_name": "TYLER",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-04",
        "last_updated": "2019-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "WI",
            "license": "5446-12",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "5446-12",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pai Participant 23 SC
• Ann M Papendorf, APNP
• Angela M Parmentier, DNP, APNP, NP-C, RN-
• Paul D. Dibley, D.D.S., S.C.
• Emma Pavletich
• Brittany L Perkins, P.T.
• Thomas G Peterson, O.D.
• Kristie R. Petry, REGISTERED NURSE
• Anthony W Phillips, M.D.
• Anton A Piantek, D.D.S.

• Chiropractor in Shawano, WI
• Providers in Shawano, WI by specialty
• Chiropractor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.