Dr Bo Tyler Headlam, MD is a medicare enrolled "Pain Medicine - Interventional Pain Medicine" physician in Portsmouth, Ohio. His current practice location is
1735 27th St, Waller Building, Suite 302, Portsmouth, Ohio. You can reach out to his office (for appointments etc.) via phone at
(740) 356-6808.
Dr Bo Tyler Headlam is licensed to practice in New York (license number 286498) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1619939246.
Physician's Profile
| Full Name | Dr Bo Tyler Headlam |
|---|
| Gender | Male |
|---|
| Speciality | Pain Medicine - Interventional Pain Medicine |
|---|
| Location | 1735 27th St, Portsmouth, Ohio |
|---|
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
|---|
NPI Data:
- NPI Number: 1619939246
- Provider Enumeration Date: 04/06/2006
- Last Update Date: 02/10/2017
Medicare PECOS Information:
- PECOS PAC ID: 8820074883
- Enrollment ID: I20161208001663
Medical Identifiers
Medical identifiers for Dr Bo Tyler Headlam such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1619939246 | NPI | - | NPPES |
| 4632039 | Other | IL | BCBS GROUP |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 2081P2900X | Physical Medicine & Rehabilitation - Pain Medicine | 25588 (Nebraska) | Secondary |
| 2081P2900X | Physical Medicine & Rehabilitation - Pain Medicine | 036115263 (Illinois) | Secondary |
| 208VP0000X | Pain Medicine - Pain Medicine | 25588 (Nebraska) | Secondary |
| 208VP0014X | Pain Medicine - Interventional Pain Medicine | 25588 (Nebraska) | Secondary |
| 208VP0014X | Pain Medicine - Interventional Pain Medicine | 036115263 (Illinois) | Secondary |
| 2081P2900X | Physical Medicine & Rehabilitation - Pain Medicine | 35120229 (Ohio) | Secondary |
| 208VP0014X | Pain Medicine - Interventional Pain Medicine | 35120229 (Ohio) | Secondary |
| 208VP0000X | Pain Medicine - Pain Medicine | 35120229 (Ohio) | Secondary |
| 2081P2900X | Physical Medicine & Rehabilitation - Pain Medicine | 286498 (New York) | Secondary |
| 208VP0014X | Pain Medicine - Interventional Pain Medicine | 286498 (New York) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Bo Tyler Headlam allows following entities to bill medicare on his behalf.
| Entity Name | Uptown Healthcare Management Inc |
|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
|---|
| Entity Identifiers | NPI Number: 1336173194
PECOS PAC ID: 4082506969
Enrollment ID: O20040325001661 |
|---|
| Entity Name | Uptown Healthcare Management Inc |
|---|
| Entity Type | Part B Supplier - Ambulatory Surgical Center |
|---|
| Entity Identifiers | NPI Number: 1669644837
PECOS PAC ID: 4082506969
Enrollment ID: O20040806001063 |
|---|
| Entity Name | Southern Wellcare Medical Pc |
|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
|---|
| Entity Identifiers | NPI Number: 1396090932
PECOS PAC ID: 9335363548
Enrollment ID: O20140610000014 |
|---|
| Entity Name | Uptown Nyc Medical Inc |
|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
|---|
| Entity Identifiers | NPI Number: 1811440456
PECOS PAC ID: 4688954035
Enrollment ID: O20161201000817 |
|---|
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Bo Tyler Headlam is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Dr Bo Tyler Headlam, MD
68 S Service Rd, Suite 100,
Melville, NY 11747-2354
Ph: (631) 465-2094 | Dr Bo Tyler Headlam, MD
1735 27th St, Waller Building, Suite 302,
Portsmouth, OH 45662-2677
Ph: (740) 356-6808 |
Reviews and Comments