Tyler John Longstreet

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

MA059462 Issued in PA

Practice address

25 Church St
Wilkes Barre, PA 18702-3507

Phone

(570) 808-3100

Fax

(570) 808-2539

NPI assigned

Oct 18, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in PA

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

Specialty

Physician Assistant

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Geisinger ClinicGroup PAC ID 5395657001, 3,432 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tlongstreet154074@direct.geisinger.edu

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.

• Geisinger Clinic

  • Family Medicine Physician
  • Danville, PA
  • NPI 1366493868
  Medicare reassignment Care Compare group
• Geisinger-HM Joint Venture, LLC

  • Family Medicine Physician
  • Lock Haven, PA
  • NPI 1144876137
  Medicare reassignment
• Geisinger Clinic

  • Diagnostic Radiology Physician
  • Danville, PA
  • NPI 1558313023
  NPD
• Geisinger Clinic

  • Family Medicine Physician
  • Wilkes Barre, PA
  • NPI 1629681150
  NPD
• Geisinger-HM Joint Venture, LLC

  • Family Medicine Physician
  • Williamsport, PA
  • NPI 1073075909

  Physician Assistant

  NPD
• Geisinger Clinic

  • Hospitalist Physician
  • Wilkes Barre, PA
  • NPI 1588614358
  NPD (past)

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

{
    "created_epoch": "1508284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652140800000",
    "number": "1124539044",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N ACADEMY AVE",
            "city": "DANVILLE",
            "state": "PA",
            "postal_code": "178224903",
            "telephone_number": "570-271-6144",
            "fax_number": "570-271-6578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 CHURCH ST",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187023507",
            "telephone_number": "570-808-3100",
            "fax_number": "570-808-2539"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 E Mountain Blvd",
            "address_purpose": "LOCATION",
            "city": "Wilkes Barre",
            "state": "PA",
            "postal_code": "187110027",
            "country_code": "US",
            "telephone_number": "570-808-7300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LONGSTREET",
        "first_name": "TYLER",
        "middle_name": "JOHN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-10-18",
        "last_updated": "2022-05-10",
        "certification_date": "2022-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "PA",
            "license": "MA059462",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA059462",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tlongstreet154074@direct.geisinger.edu",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "25 Church St",
            "city": "Wilkes Barre",
            "state": "PA",
            "country_code": "US",
            "postal_code": "187023507",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Douglas W. Long, PA-C
• Paul R. Long, M.D.
• Peggy Long
• Tanner Andrew Long, D.O.
• Maura Elizabeth Longstreet, CRNP
• Kristen Marie Lopatofsky, PHARMD
• Giselle Lopez, LPN
• Joseph Martin Lopez Jr., M.D.
• Juan Carlos Lopez, M.D.
• Bonnie Lorenzetti, CRNP

• Physician Assistant in Wilkes Barre, PA
• Providers in Wilkes Barre, PA by specialty
• Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2022; 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.