Tyler Fortman

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071008865 Issued in IL

Practice address

3354 N Paulina St
Suite 205
Chicago, IL 60657-1068

Phone

(312) 380-9031

NPI assigned

May 14, 2014

Last updated

Feb 14, 2017By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Dec 20, 2018 through Dec 20, 2026

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Tandem Psychology LLC

  • Clinical Psychologist
  • Chicago, IL
  • NPI 1811348485
  NPD (past) Authorized official

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

{
    "created_epoch": "1400025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487030400000",
    "number": "1740691542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3354 N PAULINA ST",
            "address_2": "SUITE 205",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606571068",
            "telephone_number": "312-380-9031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3354 N PAULINA ST",
            "address_2": "SUITE 205",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606571068",
            "telephone_number": "312-380-9031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORTMAN",
        "first_name": "TYLER",
        "name_prefix": "Dr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-05-14",
        "last_updated": "2017-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810004806",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071008865",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kurina Fort
• Karen Forte, LCPC, CADC
• Christopher A Fortier, MPT
• Emily J Fortman, DPT
• Katie Rose Fortman, DC
• Quaneisha Fortson, FNP-BC
• Nicole Fortuna
• John E Fortunato Jr., MD
• Joseph P Fortunato, PSY.D
• Leanna Fortunato, PHD

• Clinical Psychologist in Chicago, IL
• Providers in Chicago, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2017; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.