John Tyler Goodpasture, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT4710 Issued in AR

Practice address

2100 W Main St
Russellville, AR 72801-2758

Phone

(479) 968-2525

Fax

(479) 968-2538

NPI assigned

Aug 28, 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

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

River Valley Therapy and Sports Medicine IncGroup PAC ID 1850294018, 31 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.

• River Valley Therapy & Sports Medicine Inc

  • Physical Therapist
  • Russellville, AR
  • NPI 1619925732
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1566950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1566950400000",
    "number": "1174171607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 W MAIN ST",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728012758",
            "telephone_number": "479-968-2525",
            "fax_number": "479-968-2538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 W MAIN ST",
            "city": "RUSSELLVILLE",
            "state": "AR",
            "postal_code": "728012758",
            "telephone_number": "479-968-2525",
            "fax_number": "479-968-2538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODPASTURE",
        "first_name": "JOHN",
        "middle_name": "TYLER",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-08-28",
        "last_updated": "2019-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AR",
            "license": "PT4710",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen Gongola, DOCTOR PSYCHOTHERAPY
• Theodore Gongola
• Natassia Brooke Goodall, RN
• Jennifer Lee Goodman, LMSW
• Karmen Danielle Goodner, RN
• Megan N Goodwin, PT
• Chloe Gordon, RECOVERY ASSISTANT
• Savannah Lorraine Gordon
• Tanner S Goulet, PTA
• Grace Counseling and Consulting

• Physical Therapist in Russellville, AR
• Providers in Russellville, AR by specialty
• Physical Therapist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 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.