NPIMap

Individual provider Active NPI

Tyler Eugene Callese, MD

  • Vascular & Interventional Radiology Physician
  • Los Angeles, CA
National Provider Identifier
1073017836
Registry record updated Jul 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X
License
A164207 Issued in CA
Practice address
757 Westwood Plaza Interventional Radiology
Los Angeles, CA 90095-7419
Phone
(310) 825-8307
NPI assigned
Mar 19, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X CA
Vascular & Interventional Radiology Physician 2085R0204X A164207 CA Primary

Addresses

Primary practice location

757 Westwood Plaza Interventional Radiology
Los Angeles, CA 90095-7419

Mailing address

5767 W Century Blvd Ste 400
Los Angeles, CA 90045-5631

Other practice location 1

335 North LaBrea Avenue
Los Angeles, CA 90036
Phone (323) 634-3850

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20240716003098 NC Practitioner - Diagnostic Radiology 7911323183 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Wake Forest University School of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gaston Radiology PAGroup PAC ID 4082680806, 29 clinicians

Practice addresses (Care Compare)

2525 Court Dr
Gastonia, NC 28054-2140
Phone (704) 834-2000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.22 of 100Reported as group
Quality
95.56
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
93.78 of 100Reported as apm
Quality
80.38
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
81.13 of 100Reported as group
Quality
62.91
Promoting interoperability
100
Improvement activities
40
Cost
68.15

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A164207CAMDVascular & Interventional Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Gaston Radiology PA CurrentSince Jun 13, 2024 Accepting new patients
Martin Luther King Jr Community Medical Foundation Current Accepting new patients
UCLA Medical Group Past Accepting new patients
Gaston Memorial Hospital, Incorporated Past Accepting new patients
Regents Univ of Calif Los Angeles Past Accepting new patients

Locations

2215 W Rosecrans Ave
Ste 22
Compton, CA 90222
Phone (424) 529-6755

2525 Court Dr
Gastonia, NC 28054
Phone (704) 834-2662

620 Summit Crossing Pl
Ste 106
Gastonia, NC 28054
Phone (704) 864-4378

Organizations & group practices 5

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 7

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": "1521417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689552000000",
    "number": "1073017836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5767 W CENTURY BLVD STE 400",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900455631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "757 WESTWOOD PLAZA INTERVENTIONAL RADIOLOGY",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900957419",
            "telephone_number": "310-825-8307"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "335 North LaBrea Avenue",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "90036",
            "country_code": "US",
            "telephone_number": "323-634-3850",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CALLESE",
        "first_name": "TYLER",
        "middle_name": "EUGENE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-19",
        "last_updated": "2023-07-17",
        "certification_date": "2023-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "CA",
            "license": "A164207",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

Verify at the official NPI Registry.