Bo Tyler Headlam, M.D.

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

License

286498 Issued in NY

Practice address

1735 27TH St
Waller Building, Suite 302
Portsmouth, OH 45662-2677

Phone

(740) 356-6808

Fax

(740) 356-6826

NPI assigned

Apr 6, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 10

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Progressed Medical Professional Corporation

  • Primary Care Clinic/Center
  • Melville, NY
  • NPI 1851003636
  Medicare reassignment NPD Authorized official
• Uptown Healthcare Management Inc.

  dba East Tremont Medical Center

  • Dermatology Physician
  • Bronx, NY
  • NPI 1336173194
  Medicare reassignment NPD
• Uptown Healthcare Management, Inc.

  dba Ambulatory Surgery Center of East Tremont Medical Center

  • Ambulatory Surgical Clinic/Center
  • Bronx, NY
  • NPI 1669644837
  Medicare reassignment NPD
• Uptown Nyc Medical, Inc

  • General Practice Physician
  • New York, NY
  • NPI 1811440456

  Pain Medicine

  Medicare reassignment NPD
• BH Healthcare Medicine PC

  • Primary Care Clinic/Center
  • New York, NY
  • NPI 1942009618
  NPD Authorized official
• Uptown Healthcare Management Inc

  dba Jerome Family Health Center

  • Podiatrist
  • Bronx, NY
  • NPI 1386673937
  NPD
• American Physicians Associates LTD

  • Internal Medicine Physician
  • Chicago, IL
  • NPI 1942535661
  NPD (past)
• Barrington Orthopedic Specialists LTD

  • Orthopaedic Surgery Physician
  • Schaumburg, IL
  • NPI 1336196476
  NPD (past)
• Elmhurst Orthopaedics, SC

  • Orthopaedic Surgery Physician
  • Elmhurst, IL
  • NPI 1598716474
  NPD (past)
• Riverside Health System

  dba Psychiatric Associates

  • Psychiatry Physician
  • Kankakee, IL
  • NPI 1336354430
  NPD (past)
• Superior Healthcare LLC

  • Physical Medicine & Rehabilitation Physician
  • Canton, GA
  • NPI 1295782514
  NPD (past)

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

{
    "created_epoch": "1144281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739923200000",
    "number": "1619939246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "68 S SERVICE RD",
            "address_2": "SUITE 100",
            "city": "MELVILLE",
            "state": "NY",
            "postal_code": "117472354",
            "telephone_number": "631-465-2094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1735 27TH ST",
            "address_2": "WALLER BUILDING, SUITE 302",
            "city": "PORTSMOUTH",
            "state": "OH",
            "postal_code": "456622677",
            "telephone_number": "740-356-6808",
            "fax_number": "740-356-6826"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEADLAM",
        "first_name": "BO",
        "middle_name": "TYLER",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-06",
        "last_updated": "2025-02-19",
        "certification_date": "2025-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "NE",
            "license": "25588",
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "IL",
            "license": "036115263",
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "NE",
            "license": "25588",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "NE",
            "license": "25588",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "IL",
            "license": "036115263",
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "OH",
            "license": "35120229",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "OH",
            "license": "35120229",
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "OH",
            "license": "35120229",
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "NY",
            "license": "286498",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "NY",
            "license": "286498",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP",
            "identifier": "4632039",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelsey Hay
• Kristin Hayslip
• Larry J Hayslip
• April Haywood
• Leigh Ann Hazelton, TCADC
• Heartfelt Devotion Home Care
• Hearth & Healing Mental Health Therapy LLC
• Heartland Home Health Care Services, Inc (Heartland Home Health Care)
• Heartland of Portsmouth Oh LLC (Heartland of Portsmouth)
• Hector V Soto MD Inc

• Interventional Pain Medicine Physician in Portsmouth, OH
• Providers in Portsmouth, OH by specialty
• Interventional Pain Medicine Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.