Individual provider Active NPI

Tyler Alec Simowitz

  • Physician Assistant
  • Etters, PA
National Provider Identifier
1053997064
Registry record updated Oct 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
MA063522 Issued in PA
Practice address
36 Robinhood Dr
Etters, PA 17319-9528
Phone
(717) 388-7300
NPI assigned
Mar 20, 2021
Last updated
Oct 5, 2026By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 5, 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 25MP00646800 NJ
Physician Assistant 363A00000X MA063522 PA Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

36 Robinhood Dr
Etters, PA 17319-9528

Mailing address

601 Memory LN
York, PA 17402-2231
Phone (717) 851-1405

Other practice location 1

339 N Route 73 Ste 1
Berlin, NJ 08009-9707
Phone (856) 767-8228

Other practice location 2

1201 Letort Springs Way
Carlisle, PA 17015-8011
Phone (717) 674-7600

Other practice location 3

14781 Wolfe Rd
New Freedom, PA 17349-9571
Phone (717) 326-1880

Other practice location 4

361 Alexander Spring Rd
Carlisle, PA 17015-6940
Phone (717) 988-0000

Other practice location 5

4170 City Ave
Philadelphia, PA 19131-1610
Phone (215) 871-6100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20220913000209 PA Practitioner - Physician Assistant 9739577750 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
79.36 of 100Reported as group
Quality
56.69
Promoting interoperability
100
Improvement activities
40
Cost
74.52

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
25MP00646800NJMDPhysician Assistant
MA063522PAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
The Milton S Hershey Medical Center Physician Group CurrentSince Aug 29, 2022 Accepting new patients
Penn State Health Medical Group, LLC CurrentSince Apr 8, 2025 Accepting new patients
The Milton S Hershey Medical Center Physicians Group CurrentSince Aug 29, 2022 Accepting new patients
Penn State Health Medical Group, LLC CurrentSince Apr 8, 2025 Accepting new patients

Locations

361 Alexander Spring Rd
Carlisle, PA 17015
Phone (717) 249-1211

111 S Front St
Harrisburg, PA 17101
Phone (717) 782-3282

1120 Cocoa Ave
Hershey, PA 17033
Phone (717) 533-4141

500 University Dr
#A410
Hershey, PA 17033
Phone (717) 531-8131

Organizations & group practices 6

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

NPI Registry JSON

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

{
    "created_epoch": "1616198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1791158400000",
    "number": "1053997064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 MEMORY LN",
            "city": "YORK",
            "state": "PA",
            "postal_code": "174022231",
            "telephone_number": "717-851-1405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36 ROBINHOOD DR",
            "city": "ETTERS",
            "state": "PA",
            "postal_code": "173199528",
            "telephone_number": "717-388-7300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "339 N Route 73 Ste 1",
            "address_purpose": "LOCATION",
            "city": "Berlin",
            "state": "NJ",
            "postal_code": "080099707",
            "country_code": "US",
            "telephone_number": "856-767-8228",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1201 Letort Springs Way",
            "address_purpose": "LOCATION",
            "city": "Carlisle",
            "state": "PA",
            "postal_code": "170158011",
            "country_code": "US",
            "telephone_number": "717-674-7600",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "14781 Wolfe Rd",
            "address_purpose": "LOCATION",
            "city": "New Freedom",
            "state": "PA",
            "postal_code": "173499571",
            "country_code": "US",
            "telephone_number": "717-326-1880",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "361 Alexander Spring Rd",
            "address_purpose": "LOCATION",
            "city": "Carlisle",
            "state": "PA",
            "postal_code": "170156940",
            "country_code": "US",
            "telephone_number": "717-988-0000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4170 City Ave",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191311610",
            "country_code": "US",
            "telephone_number": "215-871-6100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SIMOWITZ",
        "first_name": "TYLER",
        "middle_name": "ALEC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-03-20",
        "last_updated": "2026-10-05",
        "certification_date": "2026-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NJ",
            "license": "25MP00646800",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA063522",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Etters, PA

Sources for this page

Verify at the official NPI Registry.