DR. BO TYLER HEADLAM (NPI# 1619939246) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619939246 |
| Entity Type | Individual |
| Full Name | DR. BO TYLER HEADLAM |
| Credential | M.D. |
| Practice Address |
1735 27th St Waller Building, Suite 302 Portsmouth OH 45662-2677 |
| Mailing Address |
68 S Service Rd Suite 100 Melville NY 11747-2354 |
| Practice Telephone | 7403566808 |
| Practice Fax Number | 7403566826 |
| Mailing Telephone | 6314652094 |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2017-02-10 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2081P2900X |
Physical Medicine & Rehabilitation Specialization: Pain Medicine |
286498 | NY | Allopathic & Osteopathic Physicians |
| N | 2081P2900X |
Physical Medicine & Rehabilitation Specialization: Pain Medicine |
35120229 | OH | Allopathic & Osteopathic Physicians |
| N | 2081P2900X |
Physical Medicine & Rehabilitation Specialization: Pain Medicine |
036115263 | IL | Allopathic & Osteopathic Physicians |
| N | 2081P2900X |
Physical Medicine & Rehabilitation Specialization: Pain Medicine |
25588 | NE | Allopathic & Osteopathic Physicians |
| N | 208VP0000X |
Pain Medicine Specialization: Pain Medicine |
35120229 | OH | Allopathic & Osteopathic Physicians |
| N | 208VP0000X |
Pain Medicine Specialization: Pain Medicine |
25588 | NE | Allopathic & Osteopathic Physicians |
| N | 208VP0014X |
Pain Medicine Specialization: Interventional Pain Medicine |
35120229 | OH | Allopathic & Osteopathic Physicians |
| N | 208VP0014X |
Pain Medicine Specialization: Interventional Pain Medicine |
036115263 | IL | Allopathic & Osteopathic Physicians |
| Y | 208VP0014X |
Pain Medicine Specialization: Interventional Pain Medicine |
286498 | NY | Allopathic & Osteopathic Physicians |
| N | 208VP0014X |
Pain Medicine Specialization: Interventional Pain Medicine |
25588 | NE | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BCBS GROUP | 4632039 | 01 |
| Street Address |
1735 27TH ST WALLER BUILDING, SUITE 302 |
| City | PORTSMOUTH |
| State | OH |
| Zip Code | 45662-2677 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952306375 | Rebecca Joan Schoettle | Pediatrics | 1735 27th St, Suite 201, Portsmouth, OH 45662-2657 | 2005-06-14 |
| 1184172538 | Carla D Williams | Social Worker | 1735 27th St, Waller Building, Suite 302, Portsmouth, OH 45662-2677 | 2016-09-14 |
| 1689054314 | Kayla Renee Harris | Nurse Practitioner | 1735 27th St, Waller Building, Suite 302, Portsmouth, OH 45662-2677 | 2015-06-08 |
| 1366874471 | Kelley Elizabeth Smith | Emergency Medicine | 1735 27th St, Waller Bldg. Suite B 06, Portsmouth, OH 45662-2677 | 2013-07-31 |
| 1285987248 | Bryan C Carney | Emergency Medicine | 1735 27th St, Waller Bldg, Suite B 06, Portsmouth, OH 45662-2677 | 2012-10-16 |
| 1396000907 | Stephanie Lynne Roberson | Emergency Medicine | 1735 27th St, Waller Bldg, Suite B 06, Portsmouth, OH 45662-2677 | 2012-07-10 |
| 1407122369 | Kathy Adams | Specialist/Technologist, Other | 1735 27th St, Portsmouth, OH 45662-2677 | 2012-03-26 |
| 1669748489 | Christopher Alan Wright | Psychiatry & Neurology | 1735 27th St, Waller Building, Suite 302, Portsmouth, OH 45662-2677 | 2012-03-26 |
| 1174807697 | Rebecca J Schoettle Pediatrics Inc | Pediatrics | 1735 27th St, Suite 201, Portsmouth, OH 45662-2677 | 2011-10-03 |
| 1396027041 | Jacinda L Paxson | Emergency Medicine | 1735 27th St, Waller Building, Suite B06, Portsmouth, OH 45662-2677 | 2011-09-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528613346 | Stacia N Boyer | Nurse Practitioner | 1611 27th Street, Fulton Bldg Suite 101, Portsmouth, OH 45662 | 2019-08-08 |
| 1487210167 | Rose Speier | Registered Nurse | 920 Gallia Street, Portsmouth, OH 45662 | 2019-05-17 |
| 1083123491 | Megan Rhea | Case Manager/Care Coordinator | 901 Wahington St, Portsmouth, OH 45662 | 2017-09-28 |
| 1376061903 | Alanna Lee Reisinger | Physical Therapist | 522 Glenwood Ave., New Boston, OH 45662 | 2017-09-04 |
| 1871010967 | Nicole Lynne Johnson | Counselor | 800 Gallia Street Suite 600, Portsmouth, OH 45662 | 2017-08-29 |
| 1629595822 | William Zachary Nance | Counselor | 800 Gallia Street, Suite 600, Portsmouth, OH 45662 | 2017-08-28 |
| 1962929703 | Melissa Rodbell | Speech-Language Pathologist | 514 Union St., Portsmouth, OH 45662 | 2017-08-23 |
| 1346604626 | Todd Davis | Counselor | 2954 Walnut St., Portsmouth, OH 45662 | 2016-04-12 |
| 1083078406 | Gordon Sanders | Counselor | 2954 Walnut Street, Portsmouth, OH 45662 | 2016-04-12 |
| 1033573910 | Michael L Purdy | Nurse Practitioner | 1735 27th Street Waller Bldg Suite 302, Portsmouth, OH 45662 | 2016-04-07 |
| Find all providers in zip 45662 | ||||
| Taxonomy Code | 208VP0014X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pain Medicine |
| Specialization | Interventional Pain Medicine |
| Interventional Pain Medicine is the discipline of medicine devoted to the diagnosis and treatment of pain and related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457639510 | Agora Pain Centers Corporation | Pain Medicine | 55 Harvest Dr, Portsmouth, RI 02871-3317 | 2011-07-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518379205 | Ips Asc, LLC | Pain Medicine | 1210 Gemini Pl Ste 301, Columbus, OH 43240-6112 | 2014-05-29 |
| 1407296650 | Dili Dhanani | Pain Medicine | 222 N 5th St Ste 203, Martins Ferry, OH 43935-1582 | 2013-07-02 |
| 1760829303 | Cleveland Medical Institute, LLC | Pain Medicine | 6025 Commerce Cir # 2, Willoughby, OH 44094-9668 | 2013-05-22 |
| 1861764250 | Ferguson Chiropractic Solutions LLC | Pain Medicine | 7058 Dayton Rd, Enon, OH 45323-1439 | 2012-02-01 |
| 1235469768 | Tri-state Pain Management Service Inc | Pain Medicine | 3020 Hospital Dr Ste 200, Batavia, OH 45103-1923 | 2010-01-06 |
| 1982727061 | Charlies I. Choi Md, Inc | Pain Medicine | 902 Westpoint Pkwy, Suite 330, Westlake, OH 44145-1534 | 2007-04-06 |
| 1891848776 | Professional Anesthesia Associates, Inc. | Pain Medicine | 605 S Trimble Rd Ste B, Mansfield, OH 44906-4112 | 2007-01-22 |
| 1629131222 | Warrensville Physical Medicine & Chiropractic Rehabilitation, LLC | Pain Medicine | 4919 Warrensville Center Rd, Warrensville Hts, OH 44128 | 2006-12-18 |
| 1194883926 | Delta Pain Consultants, Inc. | Pain Medicine | 4602 Sawmill Rd, Columbus, OH 43220-2247 | 2006-12-05 |
| 1154491611 | Tim Chowdhury | Pain Medicine | 7211 Sawmill Rd, Suite A, Dublin, OH 43016-5008 | 2006-11-09 |
| Find all providers with the same taxonomy | ||||
| City | PORTSMOUTH |
| Zip Code | 45662 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.