Individual provider Active NPI

Brian Tallman, CPO

  • Prosthetist
  • Vancouver, WA
National Provider Identifier
1568637668
Registry record updated Jun 29, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
ProsthetistTaxonomy code 224P00000X
License
PS60022981 Issued in WA
Practice address
505 NE 87TH Ave Ste LL10
Vancouver, WA 98664-1988
Phone
(360) 256-0026
NPI assigned
Apr 29, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2009

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthotist 222Z00000X OI00000478 WA
Prosthetist 224P00000X PS60022981 WA Primary

Addresses

Primary practice location

505 NE 87TH Ave Ste LL10
Vancouver, WA 98664-1988

Mailing address

505 NE 87TH Ave Ste LL10
Vancouver, WA 98664-1988
Phone (360) 256-0026

Other identifiers 1

IdentifierTypeStateIssuer
8528762MedicaidWA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
OI00000478WAMDOrthotist
PS60022981WAMDProsthetist

NPI Registry JSON

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

{
    "created_epoch": "1209427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1246233600000",
    "number": "1568637668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 NE 87TH AVE STE LL10",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986641988",
            "telephone_number": "360-256-0026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 NE 87TH AVE STE LL10",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986641988",
            "telephone_number": "360-256-0026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TALLMAN",
        "first_name": "BRIAN",
        "credential": "CPO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-29",
        "last_updated": "2009-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "222Z00000X",
            "taxonomy_group": "",
            "desc": "Orthotist",
            "state": "WA",
            "license": "OI00000478",
            "primary": false
        },
        {
            "code": "224P00000X",
            "taxonomy_group": "",
            "desc": "Prosthetist",
            "state": "WA",
            "license": "PS60022981",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8528762",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2009; 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.