Individual provider Active NPI

Tyler Chamberlin, DPT

  • Physical Therapist
  • Gorham, ME
National Provider Identifier
1134520927
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT4287 Issued in ME
Practice address
94 Main St
Gorham, ME 04038-1340
Phone
(207) 839-5860
Fax
(207) 839-2499
NPI assigned
Sep 11, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X 1250099 TX
Physical Therapist 225100000X PT4287 ME Primary

Addresses

Primary practice location

94 Main St
Gorham, ME 04038-1340

Mailing address

94 Main St
Gorham, ME 04038-1340
Phone (207) 839-5860

Other practice location 1

747 S Beckham Ave
Nova Medical Centers
Tyler, TX 75701
Phone (903) 705-4232

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ME

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171031001098 ME Practitioner - Physical Therapist in Private Practice 8628344017 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
University of New England, College of Osteo Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Back in Motion Physical Therapy LLCGroup PAC ID 7416926704, 57 clinicians

Practice addresses (Care Compare)

94 Main St
Gorham, ME 04038-1340
Phone (207) 839-5860

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1250099TXMDPhysical Medicine & Rehabilitation Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Back in Motion Physical Therapy, LLC Physical Therapist CurrentSince Oct 4, 2017 Accepting new patients

Locations

94 Main St
Gorham, ME 04038
Phone (207) 839-5225

1041 Brighton Ave
Portland, ME 04102
Phone (207) 699-4111

532 Main St
Ste 5
Saco, ME 04072
Phone (207) 820-7609

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1410393600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1134520927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "94 MAIN ST",
            "city": "GORHAM",
            "state": "ME",
            "postal_code": "040381340",
            "telephone_number": "207-839-5860",
            "fax_number": "207-839-2499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "94 MAIN ST",
            "city": "GORHAM",
            "state": "ME",
            "postal_code": "040381340",
            "telephone_number": "207-839-5860",
            "fax_number": "207-839-2499"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "747 S Beckham Ave",
            "address_2": "Nova Medical Centers",
            "address_purpose": "LOCATION",
            "city": "Tyler",
            "state": "TX",
            "postal_code": "75701",
            "country_code": "US",
            "telephone_number": "903-705-4232",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHAMBERLIN",
        "first_name": "TYLER",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-09-11",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "TX",
            "license": "1250099",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ME",
            "license": "PT4287",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gorham, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.