NPIMap

Individual provider Active NPI

Tyler K Johnson, PA-C

  • Medical Physician Assistant
  • Excelsior, MN
National Provider Identifier
1003362914
Registry record updated May 7, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
085005949 Issued in IL
Practice address
675 Water St
Excelsior, MN 55331-3072
Phone
(952) 906-7855
NPI assigned
Aug 31, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 7, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 085005949 IL Primary

Addresses

Primary practice location

675 Water St
Excelsior, MN 55331-3072

Mailing address

676 N Saint Clair St
Suite 1600
Chicago, IL 60611-2927

Other practice location 1

560 S Maple St Ste 400
Waconia, MN 55387-1757
Phone (952) 442-2191

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190315001844 MN Practitioner - Physician Assistant 2668734369 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of South Alabama College of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ridgeview Medical CenterGroup PAC ID 9234041997, 407 clinicians

Practice addresses (Care Compare)

560 S Maple St
Waconia, MN 55387-1757

7907 Powers Blvd
Chanhassen, MN 55317-9502
Phone (952) 934-0570

916 Saint Peter Ave E
Delano, MN 55328-2813
Phone (952) 442-7800

Hospital & facility affiliations

  • Ridgeview Medical Center Hospital, Waconia, MN, CCN 240056
  • Park Nicollet Methodist Hospital Hospital, Saint Louis Park, MN, CCN 240053
  • Glencoe Regional Health Hospital, Glencoe, MN, CCN 241355

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085005949ILMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Ridgeview Medical Center CurrentSince Feb 18, 2019 Accepting new patients

Locations

7907 Powers Blvd
Chanhassen, MN 55317
Phone (952) 934-0570

111 Hundertmark Rd
Ste 115N
Chaska, MN 55318
Phone (952) 361-2450

675 Water St
Excelsior, MN 55331
Phone (952) 906-7855

500 S Maple St
Waconia, MN 55387
Phone (612) 442-2191

560 S Maple St
Ste 400
Waconia, MN 55387
Phone (952) 442-3188

Organizations & group practices 2

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 9

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": "1472601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557187200000",
    "number": "1003362914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "676 N SAINT CLAIR ST",
            "address_2": "SUITE 1600",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112927"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 WATER ST",
            "city": "EXCELSIOR",
            "state": "MN",
            "postal_code": "553313072",
            "telephone_number": "952-906-7855"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "560 S Maple St Ste 400",
            "address_purpose": "LOCATION",
            "city": "Waconia",
            "state": "MN",
            "postal_code": "553871757",
            "country_code": "US",
            "telephone_number": "952-442-2191",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "TYLER",
        "middle_name": "K",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-08-31",
        "last_updated": "2019-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085005949",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Excelsior, MN

Sources for this page

Verify at the official NPI Registry.