Individual provider Active NPI

Tyler Justin Paradis, MD

  • Anesthesiology Physician
  • Vancouver, WA
National Provider Identifier
1003159096
Registry record updated Feb 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
MD60821188 Issued in WA
Practice address
400 NE Mother Joseph PL
Vancouver, WA 98664
Phone
(360) 828-5396
Fax
(360) 828-5455
NPI assigned
Mar 28, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X MD60821188 WA Primary
Anesthesiology Physician 207L00000X MD175844 OR

Addresses

Primary practice location

400 NE Mother Joseph PL
Vancouver, WA 98664

Mailing address

505 NE 87TH Ave Ste 210
Vancouver, WA 98664-1988
Phone (360) 828-5396

Other practice location 1

2211 NE 139th St
Vancouver, WA 98686-2742
Phone (360) 828-5396

Other practice location 2

1615 Delaware St
Longview, WA 98632-2367
Phone (360) 414-2000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, WA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170526001689 OR Practitioner - Anesthesiology 0345481974 Reassigns benefits to 2 organizations
I20180706000833 WA Practitioner - Anesthesiology 0345481974 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Columbia Anesthesia Group P SGroup PAC ID 8426954322, 71 clinicians
Oregon Anesthesiology Group PCGroup PAC ID 3476451659, 239 clinicians

Practice addresses (Care Compare)

1015 NW 22ND Ave
Portland, OR 97210-3025
Phone (360) 828-5396

2211 NE 139TH St
Vancouver, WA 98686-2742
Phone (360) 487-1000

400 NE Mother Joseph Place
Vancouver, WA 98664-3200
Phone (360) 256-2000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Oregon Anesthesiology Group PC Anesthesiology CurrentSince Jan 9, 2024 Accepting new patients
University Professional Services CurrentSince Jul 1, 2017 Accepting new patients
University Professional Services Current Accepting new patients
Columbia Anesthesia Group P S Anesthesiology CurrentSince Jul 16, 2018 Accepting new patients
University Professional Services CurrentSince Jul 1, 2017 Accepting new patients

Locations

15700 SW Greystone Ct
Beaverton, OR 97006
Phone (503) 203-1000

1015 NW 22nd Ave
Portland, OR 97210
Phone (503) 413-7582

3181 SW Sam Jackson Park Rd
Portland, OR 97239
Phone (503) 494-5674

7300 SW Childs Rd
Ste A
Tigard, OR 97224
Phone (360) 828-5396

1615 Delaware St
Longview, WA 98632
Phone (360) 363-4818

400 NE Mother Joseph Pl
Vancouver, WA 98664
Phone (360) 514-2000

505 NE 87th Ave
Ste 210
Vancouver, WA 98664
Phone (360) 828-5396

2211 NE 139th St
Vancouver, WA 98686
Phone (360) 397-1985

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1364428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643932800000",
    "number": "1003159096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 NE 87TH AVE STE 210",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986641988",
            "telephone_number": "360-828-5396",
            "fax_number": "360-828-5455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 NE MOTHER JOSEPH PL",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "98664",
            "telephone_number": "360-828-5396",
            "fax_number": "360-828-5455"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2211 NE 139th St",
            "address_purpose": "LOCATION",
            "city": "Vancouver",
            "state": "WA",
            "postal_code": "986862742",
            "country_code": "US",
            "telephone_number": "360-828-5396",
            "fax_number": "360-828-5455",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1615 Delaware St",
            "address_purpose": "LOCATION",
            "city": "Longview",
            "state": "WA",
            "postal_code": "986322367",
            "country_code": "US",
            "telephone_number": "360-414-2000",
            "fax_number": "360-414-7638",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PARADIS",
        "first_name": "TYLER",
        "middle_name": "JUSTIN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-03-28",
        "last_updated": "2022-02-04",
        "certification_date": "2022-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "WA",
            "license": "MD60821188",
            "primary": true
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "OR",
            "license": "MD175844",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

Verify at the official NPI Registry.