Keith Tisdell

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

113654 Issued in FL

Practice address

189 Decker
Kyle, TX 78640-5791

Phone

(954) 328-5436

NPI assigned

Jul 3, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Specialty

Occupational Therapist in Private Practice

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Legacy Healthcare Services IncGroup PAC ID 2163339722, 3,431 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.

• Legacy Healthcare Services, Inc

  • Physical Therapist
  • Tampa, FL
  • NPI 1336535988

  Occupational Therapist

  Medicare reassignment Care Compare group NPD
• Legacy Healthcare Services Inc

  • Physical Therapist
  • Cary, NC
  • NPI 1225879489

  Occupational Therapist

  NPD

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

{
    "created_epoch": "1120348800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326240000000",
    "number": "1477550630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "189 DECKER",
            "city": "KYLE",
            "state": "TX",
            "postal_code": "786405791",
            "telephone_number": "954-328-5436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "189 DECKER",
            "city": "KYLE",
            "state": "TX",
            "postal_code": "786405791",
            "telephone_number": "954-328-5436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TISDELL",
        "first_name": "KEITH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-03",
        "last_updated": "2012-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "FL",
            "license": "10016",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "FL",
            "license": "113654",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "887054300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kiera Louise Thomas
• Lanez Chanell Mona Thomas
• Jaylin Davis-Marie Thompson
• Robert Pool Thompson Jr., M.D.
• Lesley Throckmorton, PT, LMT
• TMC Provider Group, PLLC
• Scott William Tolan, M.D.
• Lauren Tolson
• Kristen Tomczyszyn, MA, LPC
• Micah D Tomlinson, M.D.

• Occupational Therapist in Kyle, TX
• Providers in Kyle, TX by specialty
• Occupational Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2012; 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.