Active NPI
Tyler Inchul An, D.O.
- Gastroenterology Physician
- Cumming, GA
National Provider Identifier
1063705135
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gastroenterology Physician
- License
- 79573
- Practice address
- 4150 Deputy Bill Cantrell Memorial Rd
Suite 290
Cumming, GA 30040-3005 - Phone
- (404) 446-0600
- Fax
- (404) 446-0601
- NPI assigned
- May 24, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 5101019313 | MI | |
| Gastroenterology Physician | 207RG0100X | 79573 | GA | Primary |
Addresses
Primary practice location
4150 Deputy Bill Cantrell Memorial Rd
Suite 290
Cumming, GA 30040-3005
Mailing address
4150 Deputy Bill Cantrell Memorial Rd
Suite 290
Cumming, GA 30040-3005
Phone (404) 446-0600
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20181219003692 | GA | Practitioner - Gastroenterology | 1254555378 | Reassigns benefits to 2 organizations |
Care Compare profile
Medicare Care Compare- Specialty
- Gastroenterology
- Education
- Philadelphia College of Osteopathic Medicine, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
4150 Deputy Bill Cantrell Memorial Rd
Suite 290
Cumming, GA 30040-7135
Phone (404) 440-0600
Hospital & facility affiliations
- Northside Hospital Forsyth
- Northside Hospital
- Northside Hospital Gwinnett
Merit-based Incentive Payment System (MIPS)
- Final score
- 75 of 100
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Colonoscopy | 154 |
| Upper gastrointestinal (GI) endoscopy for acid reflux | 200 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gi North Endoscopy.LLC | Current | Accepting new patients | |
| Gi North PC | Gastroenterology | Past | Accepting new patients |
Locations
4150 Dep Bill Cantrell Memorial Rd
Ste 200
Cumming, GA 30040
Phone (404) 446-0600
Organizations & group practices 3
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 3
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": "1306195200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1611187200000",
"number": "1063705135",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4150 DEPUTY BILL CANTRELL MEMORIAL RD",
"address_2": "SUITE 290",
"city": "CUMMING",
"state": "GA",
"postal_code": "300403005",
"telephone_number": "404-446-0600",
"fax_number": "404-446-0601"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4150 DEPUTY BILL CANTRELL MEMORIAL RD",
"address_2": "SUITE 290",
"city": "CUMMING",
"state": "GA",
"postal_code": "300403005",
"telephone_number": "404-446-0600",
"fax_number": "404-446-0601"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AN",
"first_name": "TYLER",
"middle_name": "INCHUL",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-05-24",
"last_updated": "2021-01-21",
"certification_date": "2021-01-21",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MI",
"license": "5101019313",
"primary": false
},
{
"code": "207RG0100X",
"taxonomy_group": "",
"desc": "Internal Medicine, Gastroenterology",
"state": "GA",
"license": "79573",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cumming, GA
- American Oncology Partners, P.a.
- Americans Thrive Foundation
- Jason Matthew Ames, D.M.D
- Amity One Care LLC
- Carey Elisabeth Amos Sweat, OTR/L
- Sengsouriya Ananthasane, DMD
- Sanaa Mahmoud Anbarserri, MD
- Anchored Alliance Counseling and Consulting, LLC
- Amy Alisa Anderson, RD
- Deanna Anderson, M.ED., CCC-SLP
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.