NPIMap

Individual provider Active NPI

Tyler Clark, MD

  • Family Medicine Physician
  • Coeur d'Alene, ID
National Provider Identifier
1124414305
Registry record updated Apr 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
M-14362 Issued in ID
Practice address
1701 Lincoln Way
Coeur D Alene, ID 83814-2537
Phone
(208) 625-4955
Fax
(208) 625-4956
NPI assigned
Apr 14, 2015
Last updated
Apr 16, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X M-14362 ID Primary

Addresses

Primary practice location

1701 Lincoln Way
Coeur D Alene, ID 83814-2537

Mailing address

2003 Kootenai Health Way
Coeur D Alene, ID 83814-6051
Phone (208) 625-4955

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tclark623950@direct.multicare.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
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
I20181102001987 ID Practitioner - Family Practice 0749592582 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Kootenai Health IncGroup PAC ID 1355792276, 394 clinicians

Practice addresses (Care Compare)

1055 Riverside Ave
Orofino, ID 83544-9029
Phone (208) 476-5777

1701 Lincoln Way
Coeur D Alene, ID 83814-2537
Phone (208) 625-4900

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.65 of 100Reported as apm
Quality
89.26
Promoting interoperability
69.9
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M-14362IDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kootenai Health, Inc. CurrentSince Nov 1, 2021 Accepting new patients
Kootenai Health, Inc. Current Accepting new patients
Kootenai Health, Inc. CurrentSince Jan 1, 2024 Accepting new patients
Kootenai Health, Inc. CurrentSince Nov 1, 2021 Accepting new patients
Incyte Pathology, PLLC Current Accepting new patients
Kootenai Health, Inc. CurrentSince Jan 1, 2024 Accepting new patients

Locations

1701 Lincoln Way
Coeur D Alene, ID 83814
Phone (208) 625-4955

2003 Kootenai Health Way
Coeur D Alene, ID 83814
Phone (208) 625-5085

307 Saint Johns Way
Ste 11
Lewiston, ID 83501
Phone (208) 743-7612

1300 E Mullan Ave
Ste 700
Post Falls, ID 83854
Phone (208) 625-5564

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/16883/brand/1/csg/1/fhir/r4

Organizations & group practices 6

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.

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": "1428969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713225600000",
    "number": "1124414305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2003 KOOTENAI HEALTH WAY",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838146051",
            "telephone_number": "208-625-4955",
            "fax_number": "208-625-4956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 LINCOLN WAY",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142537",
            "telephone_number": "208-625-4955",
            "fax_number": "208-625-4956"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "TYLER",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-14",
        "last_updated": "2024-04-16",
        "certification_date": "2024-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M-14362",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tclark623950@direct.multicare.org",
            "affiliation": "N",
            "address_1": "1701 Lincoln Way",
            "city": "Coeur D Alene",
            "state": "ID",
            "country_code": "US",
            "postal_code": "838142537",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Coeur d'Alene, ID

Sources for this page

Verify at the official NPI Registry.