Individual provider Active NPI

Adam Tully Mick, P.T.

  • Physical Therapist
  • Reno, NV
National Provider Identifier
1881662765
Registry record updated Jun 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
35436 Issued in CA
Practice address
9990 Double R Blvd Ste 200
Reno, NV 89521-4833
Phone
(775) 348-8800
Fax
(775) 348-8818
NPI assigned
Mar 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 1538 NV
Physical Therapist 225100000X 35436 CA Primary

Addresses

Primary practice location

9990 Double R Blvd Ste 200
Reno, NV 89521-4833

Mailing address

5310 Kietzke LN Ste 104
Reno, NV 89511-2043
Phone (775) 348-8800

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq Health Information Exchange (HIE)

Medicare participation

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

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
90.71 of 100Reported as apm
Quality
81.42
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
35436CAMDPhysical Therapist
1538NVMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
James J Lynch MD LTD CurrentSince Sep 1, 2022 Accepting new patients
James J Lynch M D LTD CurrentSince Sep 1, 2022 Accepting new patients
Ross E. Waltz PT Physical Therapist Past Accepting new patients

Locations

1470 Medical Pkwy
Ste 220
Carson City, NV 89703

1465 S Meadows Pkwy
Reno, NV 89521
Phone (775) 348-8885

9990 Double R Blvd
Ste 200
Reno, NV 89521
Phone (753) 488-8008

5310 Kietzke Ln
Ste 104
Reno, NV 89511

780 Vista Blvd
Ste 100
Sparks, NV 89434
Phone (753) 348-8800

Organizations & group practices 3

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": "1141776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654560000000",
    "number": "1881662765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5310 KIETZKE LN STE 104",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895112043",
            "telephone_number": "775-348-8800",
            "fax_number": "775-348-8818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9990 DOUBLE R BLVD STE 200",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895214833",
            "telephone_number": "775-348-8800",
            "fax_number": "775-348-8818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICK",
        "first_name": "ADAM",
        "middle_name": "TULLY",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-08",
        "last_updated": "2022-06-07",
        "certification_date": "2022-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NV",
            "license": "1538",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "35436",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "1900 Dresden Dr",
            "city": "Lincoln",
            "state": "CA",
            "country_code": "US",
            "postal_code": "956488803",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Reno, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.