NPIMap

Individual provider Active NPI

Thomas David Primavera, OT

  • Specialist
  • Oak Harbor, WA
National Provider Identifier
1821129685
Registry record updated Feb 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
OT00000933 Issued in WA
Practice address
785 SE Bayshore Dr
Suite 102
Oak Harbor, WA 98277-4062
Phone
(360) 279-8323
Fax
(360) 279-8772
NPI assigned
Mar 7, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X OT00000933 WA Primary

Addresses

Primary practice location

785 SE Bayshore Dr
Suite 102
Oak Harbor, WA 98277-4062

Mailing address

785 SE Bayshore Dr. Suite 102
Oak Harbor, WA 98277-4062
Phone (360) 279-8323

Other identifiers 1

IdentifierTypeStateIssuer
0189569OtherWADEPT OF LABOR & INDUSTRIE

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)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Bayshore Chiropractic, PS PastSince Jul 1, 2011 Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1173225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424131200000",
    "number": "1821129685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "785 SE BAYSHORE DR. SUITE 102",
            "city": "OAK HARBOR",
            "state": "WA",
            "postal_code": "982774062",
            "telephone_number": "360-279-8323",
            "fax_number": "360-279-8772"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "785 SE BAYSHORE DR",
            "address_2": "SUITE 102",
            "city": "OAK HARBOR",
            "state": "WA",
            "postal_code": "982774062",
            "telephone_number": "360-279-8323",
            "fax_number": "360-279-8772"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRIMAVERA",
        "first_name": "THOMAS",
        "middle_name": "DAVID",
        "name_prefix": "Mr.",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-07",
        "last_updated": "2015-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "WA",
            "license": "OT00000933",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF LABOR & INDUSTRIE",
            "identifier": "0189569",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oak Harbor, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2015; 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.