JOHN TYLER GOODPASTURE (PT, DPT) – Physical Therapist, NPI 1174171607

JOHN TYLER GOODPASTURE (PT, DPT) is a healthcare provider. based in Russellville, Arkansas. specializing in PHYSICAL THERAPIST IN PRIVATE PRACTICE. They hold the professional credentials PT, DPT. They hold a License No. PT4710 (AR). The NPI Number for JOHN TYLER GOODPASTURE (PT, DPT) is 1174171607

Main info

Male
7 Years Of Experience
Accepts Medicare Assignment
Name
JOHN TYLER GOODPASTURE (PT, DPT)
NPI
1174171607
Phone
(479) 968-2525
Address
2100 W MAIN ST
Enumeration Date
28 August 2019
Last Update Date
28 August 2019

Doctor Profile

Medical School Name
OTHER
Secondary Phone
4799682525
Graduation Year
2019 (7 years ago)
PAC ID
9234460528
Group Practice PAC ID
1850294018
Professional Enrollment ID
I20191017002464
Address ID
AR728012758RU2100XSTXX400
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience26
Completeness75
Years active:6State licenses:1Digital endpointsOther names

835 PHYSICAL THERAPIST IN PRIVATE PRACTICE in AR

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Provider Addresses for JOHN TYLER GOODPASTURE (PT, DPT)

  • 2100, West Main Street, Ouitaville, Illinois Township, Russellville, Pope County, Arkansas, 72801, United States

    RUSSELLVILLE, AR 728012758

    Phone: (479) 968-2525

    Fax: (479) 968-2538

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2019-10-17

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20191017002464IPhysical Therapist In Private PracticeARTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
97110Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes713121$0
97112Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes29561$0
97530Therapy procedure using functional activities24358$0
G0283Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care9042$0
97140Therapy procedure using manual technique, each 15 minutes8928$0
View full utilization report →

Insurance plans in this area (ZIP 72801)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 1850294018View full group profile
NameSpecialtyState
-AR
Physical Therapist In Private PracticeAR
Physical Therapist In Private PracticeAR
Physical Therapist In Private PracticeAR
-AR
Physical Therapist In Private PracticeAR
Physical Therapist In Private PracticeAR
Physical Therapist In Private PracticeAR
Physical Therapist In Private PracticeAR
Physical Therapist In Private PracticeAR

Reviews

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Frequently asked questions

What number should I use to identify JOHN TYLER GOODPASTURE (PT, DPT) for billing?
Administrative and clinical systems typically use NPI 1174171607 for JOHN TYLER GOODPASTURE (PT, DPT).
Should I treat JOHN TYLER GOODPASTURE (PT, DPT) as an active provider?
Patients and plans typically see JOHN TYLER GOODPASTURE (PT, DPT) as active in the national extract.
What does the directory say JOHN TYLER GOODPASTURE (PT, DPT) does?
Insurance directories may phrase it differently, but here JOHN TYLER GOODPASTURE (PT, DPT) maps to Physical Therapist. Clinical services aligned with this taxonomy classification.
Can patients visit JOHN TYLER GOODPASTURE (PT, DPT) in Russellville, Arkansas?
For routing, start with Russellville, Arkansas for JOHN TYLER GOODPASTURE (PT, DPT), then verify phone and hours locally.
Can I verify credentials using only NPI?
NPI confirms identity in the directory; licensure and board certification require separate checks.

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