Individual provider Active NPI

Tyler Wundrach, PA-C

  • Physician Assistant
  • Clinton TWP, MI
National Provider Identifier
1033894910
Registry record updated Jul 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601011785 Issued in MI
Practice address
15855 19 Mile Rd
Clinton TWP, MI 48038-3504
Phone
(586) 263-2320
Fax
(586) 203-1050
NPI assigned
Jun 19, 2023
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 15, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601011785 MI Primary
Surgical Physician Assistant 363AS0400X 5601011785 MI
Trauma Surgery Physician 2086S0127X 5601011785 MI

Addresses

Primary practice location

15855 19 Mile Rd
Clinton TWP, MI 48038-3504

Mailing address

1 Ford PL Ste 3a
Detroit, MI 48202-3450
Phone (800) 999-5829

Other practice location 1

1 Hurley Plz # 7B
Flint, MI 48503-5902
Phone (810) 262-9355

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address twundrach117169@direct.hurleymc.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230808004025 MI Practitioner - Physician Assistant 5496117459 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Wayne State University School of Medicine, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hurley Medical CenterGroup PAC ID 2961308481, 336 clinicians

Practice addresses (Care Compare)

1 Hurley Plasa
9W Hurley Maternal Fetal Medicine
Flint, MI 48503-5902
Phone (810) 262-4787

1 Hurley PLZ
Flint, MI 48503-5902

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.4 of 100Reported as group
Quality
66.97
Promoting interoperability
100
Improvement activities
40
Cost
75.88

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science, Physician Assistant

State licenses

LicenseStateTypeSpecialty
5601011785MIMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Hurley Medical Center Physician Assistant CurrentSince Aug 1, 2023 Accepting new patients
Hurley Medical Center Physician Assistant Current Accepting new patients
Henry Ford Health St. John Hospital CurrentSince Nov 1, 2025 Accepting new patients
Pathology Associates Inc PC Current Accepting new patients
Henry Ford Health St. John Hospital Current Accepting new patients
Hurley Medical Center Current Accepting new patients
Henry Ford Health St. John Hospital CurrentSince Nov 1, 2025 Accepting new patients
Pathology Specialists of Southeast Michigan PC Current Accepting new patients
Hurley Medical Center CurrentSince Aug 1, 2023 Accepting new patients
Hurley Medical Center CurrentSince Aug 1, 2023 Accepting new patients
St. John Hospital Past Accepting new patients

Locations

22101 Moross Rd
Detroit, MI 48236
Phone (313) 343-3248

22101 Moross Rd
Ste 212
Detroit, MI 48236
Phone (313) 343-3485

1 Hurley Plz
Flint, MI 48503
Phone (810) 257-9000

1 Hurley Plz
#7B
Flint, MI 48503
Phone (810) 262-9355

Organizations & group practices 12

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 1

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": "1687132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784073600000",
    "number": "1033894910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 FORD PL STE 3A",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482023450",
            "telephone_number": "800-999-5829",
            "fax_number": "313-876-1305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15855 19 MILE RD",
            "city": "CLINTON TWP",
            "state": "MI",
            "postal_code": "480383504",
            "telephone_number": "586-263-2320",
            "fax_number": "586-203-1050"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Hurley Plz # 7B",
            "address_purpose": "LOCATION",
            "city": "Flint",
            "state": "MI",
            "postal_code": "485035902",
            "country_code": "US",
            "telephone_number": "810-262-9355",
            "fax_number": "810-262-6341",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WUNDRACH",
        "first_name": "TYLER",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-06-19",
        "last_updated": "2026-07-15",
        "certification_date": "2026-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601011785",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "MI",
            "license": "5601011785",
            "primary": false
        },
        {
            "code": "2086S0127X",
            "taxonomy_group": "",
            "desc": "Surgery, Trauma Surgery",
            "state": "MI",
            "license": "5601011785",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "twundrach117169@direct.hurleymc.com",
            "affiliation": "N",
            "address_1": "1 Hurley Plz # 7B",
            "city": "Flint",
            "state": "MI",
            "country_code": "US",
            "postal_code": "485035902",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Clinton TWP, MI

Sources for this page

Verify at the official NPI Registry.