Individual provider Active NPI

Tyler Louis Johnston, MD

  • Emergency Medicine Physician
  • Toledo, OH
National Provider Identifier
1104445253
Registry record updated Aug 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
MED-PHYS-LIC-141522 Issued in MT
Practice address
5923 Renaissance PL
Toledo, OH 43623-4709
Phone
(567) 408-2002
Fax
(419) 214-1196
NPI assigned
Apr 9, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 35.145371 OH
Emergency Medicine Physician 207P00000X MED-PHYS-LIC-141522 MT Primary

Addresses

Primary practice location

5923 Renaissance PL
Toledo, OH 43623-4709

Mailing address

2213 Cherry St
Toledo, OH 43608-2603

Other practice location 1

500 W Broadway St
Missoula, MT 59802-4008
Phone (406) 329-5635

Other practice location 2

6 13th Ave E
Polson, MT 59860-5315
Phone (406) 329-5635

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, MT2 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

Enrollment IDStateProvider typePAC IDDetails
I20220803002933 OH Practitioner - Emergency Medicine 6204258023 Reassigns benefits to 6 organizations
I20240610003363 MT Practitioner - Emergency Medicine 6204258023 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Toledo College of Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Health and Services MtGroup PAC ID 6608786306, 358 clinicians

Practice addresses (Care Compare)

500 W Broadway St
Missoula, MT 59802-4008
Phone (406) 329-5828

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MED-PHYS-LIC-141522MTMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Health & Services Mt Current Accepting new patients
Observation Physicians of Northwest Ohio LLC Emergency Medicine CurrentSince Jul 1, 2023 Accepting new patients
The Toledo Hospital CurrentSince Jul 22, 2023 Accepting new patients
Mercy Emergency Care Services, Inc. Emergency Medicine CurrentSince Jan 1, 2023 Accepting new patients
Williams Emergency Group, LLC Emergency Medicine CurrentSince Jun 21, 2022 Accepting new patients
Emergency Professional Services, Inc. Emergency Medicine CurrentSince Oct 1, 2022 Accepting new patients
Credena Health LLC CurrentSince Aug 1, 2024 Accepting new patients
Haematology-Oncology Associates of Ohio and Michigan PC Current Accepting new patients
Providence St Joseph Medical Center CurrentSince Aug 1, 2024 Accepting new patients
The Toledo Hospital CurrentSince Jul 22, 2023 Accepting new patients
Providence Health & Services Mt CurrentSince Jul 15, 2024 Accepting new patients
Providence Health & Services Mt CurrentSince Jul 15, 2024 Accepting new patients
Consultants in Laboratory Medicine of Greater Toledo Current Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients

Locations

718 N Macomb St
Monroe, MI 48162
Phone (734) 212-3097

500 W Broadway St
Missoula, MT 59802
Phone (406) 327-1918

500 W Broadway St
Ste 320
Missoula, MT 59802
Phone (406) 329-2945

6 13th Ave E
Polson, MT 59860
Phone (406) 883-5377

433 W High St
Bryan, OH 43506
Phone (419) 636-1131

1075 Medical Center Pkwy
Maumee, OH 43537
Phone (567) 585-0800

18697 Bagley Rd
Middleburg Heights, OH 44130
Phone (440) 816-8000

909 E Snyder Ave
Montpelier, OH 43543
Phone (419) 485-3154

2600 Navarre Ave
Oregon, OH 43616
Phone (419) 696-7200

2213 Cherry St
Toledo, OH 43608
Phone (419) 251-4283

2142 N Cove Blvd
Toledo, OH 43606
Phone (419) 291-1111

Organizations & group practices 15

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.

View all 15

Hospital & facility affiliations 4

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": "1586390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722470400000",
    "number": "1104445253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2213 CHERRY ST",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436082603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5923 RENAISSANCE PL",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436234709",
            "telephone_number": "567-408-2002",
            "fax_number": "419-214-1196"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 W Broadway St",
            "address_purpose": "LOCATION",
            "city": "Missoula",
            "state": "MT",
            "postal_code": "598024008",
            "country_code": "US",
            "telephone_number": "406-329-5635",
            "fax_number": "406-327-2160",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6 13th Ave E",
            "address_purpose": "LOCATION",
            "city": "Polson",
            "state": "MT",
            "postal_code": "598605315",
            "country_code": "US",
            "telephone_number": "406-329-5635",
            "fax_number": "406-327-2160",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSTON",
        "first_name": "TYLER",
        "middle_name": "LOUIS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-09",
        "last_updated": "2024-08-01",
        "certification_date": "2024-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "OH",
            "license": "35.145371",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MT",
            "license": "MED-PHYS-LIC-141522",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Toledo, OH

Sources for this page

Verify at the official NPI Registry.