Tyler Daniel Petersen, D.O.

Primary specialty

Orthopaedic Trauma PhysicianTaxonomy code 207XX0801X

License

OP61629112 Issued in WA

Practice address

200 NE Mother Joseph PL Ste 110
Vancouver, WA 98664-3293

Phone

(360) 254-6161

Fax

(360) 803-0847

NPI assigned

Apr 26, 2015

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 PA, WA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Orthopedic Surgery

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northwest Surgical Specialists PCGroup PAC ID 4183527153, 118 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Peacehealth Southwest Medical Cente Hospital, Vancouver, WA, CCN 500050

Merit-based Incentive Payment System (MIPS)

Final score

80.94 of 100Reported as group

Quality

61.89

Promoting interoperability

100

Improvement activities

40

Cost

74.58

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tyler.d.petersen@upmcdirect.com
• Direct secure messaging: tyler.petersen.p1@direct.reboundmd.nextgenshare.com
• Direct secure messaging: tpetersen135334@samhealth.direct-ci.com

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.

• Northwest Surgical Specialists, P.C.

  dba Rebound Orthopedics & Neurosurgical Specialists

  • Orthopaedic Surgery Physician
  • Portland, OR
  • NPI 1730118803

  WA

  Medicare reassignment Care Compare group NPD
• University of Pittsburgh Physicians

  • Gastroenterology Physician
  • Pittsburgh, PA
  • NPI 1619935004
  Medicare reassignment NPD
• Northwest Surgical Specialists PC

  dba Rebound Physical Therapy Salmon Creek

  • Durable Medical Equipment & Medical Supplies
  • Vancouver, WA
  • NPI 1821510306
  NPD
• University of Pittsburgh Physicians

  • Diagnostic Radiology Physician
  • Pittsburgh, PA
  • NPI 1285692699
  NPD
• University of Pittsburgh Physicians

  • Orthopaedic Surgery Physician
  • Pittsburgh, PA
  • NPI 1720036601
  NPD
• Upmc Presbyterian Shadyside

  • General Acute Care Hospital
  • Pittsburgh, PA
  • NPI 1821007881
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Peacehealth

  dba PeaceHealth SW Heart & Vascular Center

  • Cardiovascular Disease Physician
  • Vancouver, WA
  • NPI 1003194911

  Hospital

  Care Compare affiliation
• Peacehealth

  dba PeaceHealth Southwest Medical Center

  • General Acute Care Hospital
  • Vancouver, WA
  • NPI 1134178999
  Care Compare affiliation

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

{
    "created_epoch": "1430006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763683200000",
    "number": "1093102220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 NE MOTHER JOSEPH PL STE 210",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986643295",
            "telephone_number": "360-254-6161",
            "fax_number": "360-803-0847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 NE MOTHER JOSEPH PL STE 110",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986643293",
            "telephone_number": "360-254-6161",
            "fax_number": "360-803-0847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "TYLER",
        "middle_name": "DANIEL",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-26",
        "last_updated": "2025-11-21",
        "certification_date": "2025-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XX0801X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Trauma",
            "state": "WA",
            "license": "OP61629112",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bryanne Petersen, BS, CDP
• Donald E. Petersen, ADDICTION THERAPIST
• Karrie Janae Petersen, MS, CCC- SLP
• Mari Petersen
• Markell Petersen, SUDP
• Zoe Peterson-Lipetz
• Alex Michael Peterson, PHARM. D
• Andrew Steve Peterson
• Angel Peterson
• Anna Christine Peterson, MA, LMHC, NCC

• Orthopaedic Trauma Physician in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Orthopaedic Trauma Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2025; 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.

Verify at the official NPI Registry.