Individual provider Active NPI

Eric Preston Tamura, DPT

  • Physical Therapist
  • Meridian, ID
National Provider Identifier
1306121710
Registry record updated Dec 30, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
6577 Issued in OR
Practice address
3035 W McMillan Rd
Suite 104
Meridian, ID 83646-6163
Phone
(208) 887-8684
NPI assigned
Oct 17, 2011
Last updated
Dec 30, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 6577 OR Primary

Addresses

Primary practice location

3035 W McMillan Rd
Suite 104
Meridian, ID 83646-6163

Mailing address

14436 W Kettle Creek Dr
Boise, ID 83713-2030
Phone (208) 891-7887

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120307000381 ID Practitioner - Physical Therapist in Private Practice 4284893454 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gridiron Rehab and Athletic Fitness LLCGroup PAC ID 4385794692, 4 clinicians

Practice addresses (Care Compare)

3035 W McMillan Rd
Suite 104
Meridian, ID 83646-6162
Phone (208) 887-8684

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6577ORMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Gridiron Rehab and Athletic Fitness, LLC CurrentSince Jan 3, 2012 Accepting new patients

Locations

3035 W McMillan Rd
Ste 104
Meridian, ID 83646
Phone (208) 887-8684

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1318809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325203200000",
    "number": "1306121710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14436 W KETTLE CREEK DR",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837132030",
            "telephone_number": "208-891-7887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3035 W MCMILLAN RD",
            "address_2": "SUITE 104",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836466163",
            "telephone_number": "208-887-8684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAMURA",
        "first_name": "ERIC",
        "middle_name": "PRESTON",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-10-17",
        "last_updated": "2011-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "6577",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2011; 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.