Tyler Andrew Peterson, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

20A19747 Issued in CA

Practice address

1115 S Sunset Ave
West Covina, CA 91790-3940

Phone

(626) 962-4011

NPI assigned

Jun 8, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

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 1

Specialty

Family PracticeAlso: Hospitalist

Education

Touro Un College of Osteopathic Medicine, Vallejo, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Regents of the University of California-IrvineGroup PAC ID 3971609611, 116 clinicians

Memorialcare Medical FoundationGroup PAC ID 8729277314, 555 clinicians

Southern California Hospitalist Network Medical Group IncGroup PAC ID 8921990110, 76 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Emanate Health Inter-Community Hospital Hospital, Covina, CA, CCN 050382
• Uci Health-Orange Hospital, Orange, CA, CCN 050348

Merit-based Incentive Payment System (MIPS)

Final score

87.17 of 100Reported as group

Quality

81.15

Promoting interoperability

100

Improvement activities

40

Cost

71.64

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

• Direct secure messaging: tpeterson812140@direct.memorialcare.org

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.

• Memorialcare Medical Foundation

  • Clinic/Center
  • Fountain Valley, CA
  • NPI 1205167350

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Southern California Hospitalist Network Medical Group Inc

  • Internal Medicine Physician
  • Orange, CA
  • NPI 1790880458
  Medicare reassignment Care Compare group NPD
• The Regents of the University of California-Irvine

  • Hospitalist Physician
  • Orange, CA
  • NPI 1154479723
  Medicare reassignment Care Compare group
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Baldwin Park, CA
  • NPI 1770515280
  Medicare reassignment NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Santa Clarita, CA
  • NPI 1316409410
  NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Anaheim, CA
  • NPI 1952333460
  NPD
• Bristol Park Medical Group, Inc

  • Family Medicine Physician
  • Costa Mesa, CA
  • NPI 1043266760
  NPD (past)

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

• Emanate Health Medical Center

  • General Acute Care Hospital
  • West Covina, CA
  • NPI 1063441293
  Care Compare affiliation
• Emanate Health Medical Center

  • Psychiatric Hospital Unit
  • Covina, CA
  • NPI 1215063151
  Care Compare affiliation
• Emanate Health Medical Center

  • General Acute Care Hospital
  • Covina, CA
  • NPI 1982629440
  Care Compare affiliation
• University of California Irvine

  • Urgent Care Clinic/Center
  • Irvine, CA
  • NPI 1518739309

  Hospital

  Care Compare affiliation
• University of California Irvine

  • General Acute Care Hospital
  • Orange, CA
  • NPI 1689608150
  Care Compare affiliation

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

{
    "created_epoch": "1591574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709596800000",
    "number": "1124643960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2040 S SANTA CRUZ ST STE 240",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928056805",
            "telephone_number": "714-202-2330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1115 S SUNSET AVE",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917903940",
            "telephone_number": "626-962-4011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "TYLER",
        "middle_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-06-08",
        "last_updated": "2024-03-05",
        "certification_date": "2024-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "20A19747",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "441 N Lakeview Ave",
            "city": "Anaheim",
            "state": "CA",
            "country_code": "US",
            "postal_code": "928073028",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Shawn Nathaniel Perla, RDH
• Livia Csonka Marta Perry, N.P.
• Personal Emergency Response Systems, Inc.
• Juan Pablo Pesqueira Gonzalez, MD
• Peter J Lee DDS Inc
• Sonja Singleton Peverieri, M.A.
• Anthony Tuan Pham
• Vivian T Pham, FNP-BC
• Andy Hoang Phan, PHARMD
• Anthony Wong Phan

• Family Medicine Physician in West Covina, CA
• Providers in West Covina, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2024; 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.