Tyler Lee Anderson, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA10003435 Issued in WA

Practice address

1119 Highland Ave Ste 4
Clarkston, WA 99403-2836

Phone

(509) 254-0080

Fax

(509) 254-0079

NPI assigned

Jul 22, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tyler.anderson@tsmh.medicity.net

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.

• Tri-State Memorial Hospital

  • Critical Access Hospital
  • Clarkston, WA
  • NPI 1598814352
  Medicare reassignment NPD
• Tri-State Memorial Hospital

  • Critical Access Hospital
  • Clarkston, WA
  • NPI 1760485221
  Medicare reassignment NPD
• Tri-State Memorial Hospital

  • Community Based Hospice Care Agency
  • Clarkston, WA
  • NPI 1831100254
  NPD

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

{
    "created_epoch": "1279756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1279756800000",
    "number": "1083927792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1119 HIGHLAND AVE STE 4",
            "city": "CLARKSTON",
            "state": "WA",
            "postal_code": "994032836",
            "telephone_number": "509-254-0080",
            "fax_number": "509-254-0079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1119 HIGHLAND AVE STE 4",
            "city": "CLARKSTON",
            "state": "WA",
            "postal_code": "994032836",
            "telephone_number": "509-254-0080",
            "fax_number": "509-254-0079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "TYLER",
        "middle_name": "LEE",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-22",
        "last_updated": "2010-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA10003435",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charmaine R Allen-Johnson, ARNP
• Elizabeth Marie Allen-Racicot, L.M.P.
• Alpowa Healthcare, Inc.
• Jennifer D Ambriz, MASTER ED
• Ashley Nicole Anderson
• Angelic Care LLC
• Heidi Appleton
• Arora Consultants LLC
• Eliel N Arrey, MD, PHD., MBA
• Asotin County Community Services

• Medical Physician Assistant in Clarkston, WA
• Providers in Clarkston, WA by specialty
• Medical Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2010; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.