Individual provider Active NPI

Tyler Burcham, DPT

  • Physical Therapist
  • Fargo, ND
National Provider Identifier
1912138231
Registry record updated Jun 6, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1738 Issued in ND
Practice address
3170 43Rd St S
Suite 101
Fargo, ND 58104-8908
Phone
(701) 277-8448
Fax
(701) 277-8668
NPI assigned
Aug 4, 2009
Last updated
Jun 6, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2013

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X PT2542 ID
Physical Therapist 225100000X 1738 ND Primary
Physical Therapist 225100000X PT-2542 ID

Addresses

Primary practice location

3170 43Rd St S
Suite 101
Fargo, ND 58104-8908

Mailing address

1560 S Carol St
Meridian, ID 83646-1839
Phone (208) 288-1155

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130708000483 ND Practitioner - Physical Therapist in Private Practice 2769538065 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rehabauthority LLCGroup PAC ID 1355333931, 48 clinicians

Practice addresses (Care Compare)

1100 19TH Ave N
Suite K
Fargo, ND 58102-2269
Phone (701) 235-1400

3170 43Rd St S
Suite 101
Fargo, ND 58104-8908
Phone (701) 277-8448

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1738NDMDDentist
PT2542IDMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Rehabauthority, LLC Physical Therapist CurrentSince Jun 15, 2013 Accepting new patients

Locations

10790 W Overland Rd
Boise, ID 83709
Phone (208) 322-8709

5520 N Eagle Rd
Ste 102
Boise, ID 83713
Phone (208) 938-5255

1560 S Carol St
Meridian, ID 83646
Phone (208) 495-4317

3921 Lockport St
Bismarck, ND 58503
Phone (701) 751-3125

1100 19th Ave N
Ste K
Fargo, ND 58102
Phone (701) 235-1400

3170 43rd St S
Ste 101
Fargo, ND 58104
Phone (701) 277-8448

701 Demers Ave
#B
Grand Forks, ND 58201
Phone (701) 772-2200

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1249344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370476800000",
    "number": "1912138231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1560 S CAROL ST",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836461839",
            "telephone_number": "208-288-1155",
            "fax_number": "208-288-0424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3170 43RD ST S",
            "address_2": "SUITE 101",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581048908",
            "telephone_number": "701-277-8448",
            "fax_number": "701-277-8668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURCHAM",
        "first_name": "TYLER",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-08-04",
        "last_updated": "2013-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "ID",
            "license": "PT2542",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ND",
            "license": "1738",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "PT-2542",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.