Individual provider Active NPI

Thomas Patrick Entwistle, D.C.

  • Chiropractor
  • Kissimmee, FL
National Provider Identifier
1528353497
Registry record updated Nov 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CH 9645 Issued in FL
Practice address
1611 N Main St
Kissimmee, FL 34744-3304
Phone
(407) 344-4878
Fax
(407) 344-7878
NPI assigned
Jun 18, 2011
Last updated
Nov 16, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 16, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X CH 9645 FL Primary

Addresses

Primary practice location

1611 N Main St
Kissimmee, FL 34744-3304

Mailing address

1611 N Main St
Kissimmee, FL 34744-3304
Phone (407) 344-4878

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120613000608 FL Practitioner - Chiropractic 9234393737 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
New York Chiropractic College, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Central Florida Accident and InjuryGroup PAC ID 8527222025, 2 clinicians

Practice addresses (Care Compare)

17315 Pagonia Rd
Suite 103
Clermont, FL 34711-5956
Phone (407) 344-4878

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CH 9645FLMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Central Florida Accident and Injury CurrentSince May 30, 2012 Accepting new patients

Locations

17315 Pagonia Rd
Ste 103
Clermont, FL 34711
Phone (407) 344-4878

1611 N Main St
Kissimmee, FL 34744
Phone (407) 344-4878

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": "1308355200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637020800000",
    "number": "1528353497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1611 N MAIN ST",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347443304",
            "telephone_number": "407-344-4878",
            "fax_number": "407-344-7878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1611 N MAIN ST",
            "city": "KISSIMMEE",
            "state": "FL",
            "postal_code": "347443304",
            "telephone_number": "407-344-4878",
            "fax_number": "407-344-7878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENTWISTLE",
        "first_name": "THOMAS",
        "middle_name": "PATRICK",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-06-18",
        "last_updated": "2021-11-16",
        "certification_date": "2021-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "FL",
            "license": "CH 9645",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kissimmee, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2021; 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.