NPIMap

Organization Active NPI

Healthport P.a.

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Tyler, TX
National Provider Identifier
1154577641
Registry record updated Jan 7, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X
Legal business name
HEALTHPORT P.A.
Practice address
4295 Kinsey Dr
Tyler, TX 75703-1004
Phone
(903) 526-5000
Fax
(903) 526-5006
NPI assigned
Aug 15, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2013

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

Authorized official

Name
Dr. Kenneth Fults, D.O.
Title
President
Phone
(903) 526-5000

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081P2900X Primary
Interventional Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0014X

Addresses

Primary practice location

4295 Kinsey Dr
Tyler, TX 75703-1004

Mailing address

4295 Kinsey Dr
Tyler, TX 75703-1004
Phone (903) 526-5000

Other identifiers 2

IdentifierTypeStateIssuer
208679501MedicaidTX
0066SGOtherTXBCBS

Other names 1

  • PAIN RECOVERY CENTER OF TYLER Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1218758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357516800000",
    "number": "1154577641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4295 KINSEY DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757031004",
            "telephone_number": "903-526-5000",
            "fax_number": "903-526-5006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4295 KINSEY DR",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757031004",
            "telephone_number": "903-526-5000",
            "fax_number": "903-526-5006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHPORT P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-15",
        "last_updated": "2013-01-07",
        "status": "A",
        "authorized_official_last_name": "FULTS",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "903-526-5000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "208679501",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0066SG",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PAIN RECOVERY CENTER OF TYLER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tyler, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.