Active NPI
Tyler James Gould, PHD
- Psychologist
- South Burlington, VT
National Provider Identifier
1720150691
On this page
OIG exclusion record
The HHS Office of Inspector General’s List of Excluded Individuals/Entities (LEIE) contains a record with this NPI:
- Section 1128b(4) exclusion effective Aug 20, 2013.
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 048-0000788
- Practice address
- 1 Kennedy Dr
Suite U8
South Burlington, VT 05403-7152 - Phone
- (802) 864-4513
- Fax
- (802) 878-1903
- NPI assigned
- Nov 15, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 048-0000788 | VT | Primary |
Addresses
Primary practice location
1 Kennedy Dr
Suite U8
South Burlington, VT 05403-7152
Mailing address
1 Kennedy Dr
Suite U8
South Burlington, VT 05403-7152
Phone (802) 864-4513
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 28635 | Other | VT | BLUE CROSS BLUE SHIELD VT |
| 1007391 | Medicaid | VT |
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
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 048-0000788 | VT | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1720150691",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 KENNEDY DR",
"address_2": "SUITE U8",
"city": "SOUTH BURLINGTON",
"state": "VT",
"postal_code": "054037152",
"telephone_number": "802-864-4513",
"fax_number": "802-878-1903"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 KENNEDY DR",
"address_2": "SUITE U8",
"city": "SOUTH BURLINGTON",
"state": "VT",
"postal_code": "054037152",
"telephone_number": "802-864-4513",
"fax_number": "802-878-1903"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOULD",
"first_name": "TYLER",
"middle_name": "JAMES",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-15",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "VT",
"license": "048-0000788",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD VT",
"identifier": "28635",
"state": "VT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1007391",
"state": "VT"
}
],
"endpoints": [],
"other_names": []
}Other providers in South Burlington, VT
- Goodhealth Diagnostic Center, Inc.
- Goodhealth P.C.
- Goodhealth, P.C. (Good Health Diagnostic Center, Inc.)
- Robert Macy Goodman, M.A., M.S.
- Joanna Gould, LADC,LCMHC
- Ryan James Gouvin
- Jason Gramling, MD
- Brittany Granara, APRN (NP)
- Granite Ridge Counseling, LCC (Granite Ridge Counseling)
- Michael William Gravett, N.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.