Tylen Joe Pavlovsky, PA-C
Individual provider Active NPI Physician Assistant · Alamosa, CO
NPI 1013621697 · NPPES record last updated Jan 9, 2023
Key facts
- NPI
- 1013621697
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA.0007719 (CO)
- Practice address
- 106 Blanca Ave
Alamosa, CO 81101-2340 - Phone
- (719) 589-3000
- NPI assigned
- Jan 9, 2023
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 8
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Creighton University School of Medicine, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Lutheran Hospital Association of the San Luis Valley
Practice addresses (Care Compare)
106 Blanca Ave
Alamosa, CO 81101-2340
Phone (719) 589-2511
310 County Rd
Suite 14
Del Norte, CO 81132-8758
Phone (719) 657-2510
Hospital & facility affiliations
- San Luis Valley Regional Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230124003156 | CO | Practitioner - Physician Assistant | 6103297494 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA.0007719 | CO | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lutheran Hospital Association of the San Luis Valley | Physician Assistant | Current |
Accepting new patients |
| Lutheran Hospital Association of the San Luis Valley | Past | Accepting new patients |
Locations
106 Blanca Ave
Alamosa, CO 81101
Phone (719) 589-2511
2115 Stuart Ave
Alamosa, CO 81101
Phone (719) 589-3000
2115 Stuart Ave
#A
Alamosa, CO 81101
Phone (719) 589-3000
310 County Road 14
Del Norte, CO 81132
Phone (719) 657-2510
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA.0007719 | CO | Yes |
Addresses
Primary practice location
106 Blanca Ave
Alamosa, CO 81101-2340
Mailing address
106 Blanca Ave
Alamosa, CO 81101-2340
Phone (719) 589-3000
Other providers in Alamosa, CO
- Scott Spencer Parker
- Partner for Health, LLC
- Patricia A Paterson
- Kristy Iway Patigdas
- Paul K Reed Recovery Center
- Katie Sue Payne
- Marita Elaine Peak
- Pediatric Psychology Services of Colorado
- Therese Margaret Peloquin
- Ann-Marie Peterson
All providers in Alamosa, CO · Physician Assistant in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 9, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.