Lincoln Performance and Sports Medicine, LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

LINCOLN PERFORMANCE AND SPORTS MEDICINE, LLC

Practice address

1220 Aries Dr
Lincoln, NE 68512-9632

Phone

(402) 480-7070

NPI assigned

Aug 10, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Tyler Mark Ideus, D.C.NPI 1174827224

Title

Physician

Phone

(402) 239-2298

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NE

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tyler Mark Ideus, D.C.

  • Chiropractor
  • Lincoln, NE
  • NPI 1174827224
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1565395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606953600000",
    "number": "1891341467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1220 ARIES DR",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685129632",
            "telephone_number": "402-480-7070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 ARIES DR",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685129632",
            "telephone_number": "402-480-7070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LINCOLN PERFORMANCE AND SPORTS MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-10",
        "last_updated": "2020-12-03",
        "certification_date": "2020-12-03",
        "status": "A",
        "authorized_official_last_name": "IDEUS",
        "authorized_official_first_name": "TYLER",
        "authorized_official_middle_name": "MARK",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "402-239-2298",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lincoln Orthopedic Physical Therapy PC
• Lincoln Orthopedic Physical Therapy PC
• Lincoln Pain Management & Rehab, LLC
• Lincoln Pediatric Group LLC
• Lincoln Pediatric Group LLC
• Lincoln Pharmacy LLC
• Lincoln Pharmacy LLC
• Lincoln Physical Therapy and Sports Rehab LLC
• Lincoln Physical Therapy and Sports Rehab LLC
• Lincoln Physical Therapy and Sports Rehab LLC

• Chiropractor in Lincoln, NE
• Providers in Lincoln, NE by specialty
• Chiropractor in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.