Tyler Stoltman, ACT/LAT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

2013028788 Issued in MO

Practice address

19550 E 39TH St S Ste 230
Independence, MO 64057-2309

Phone

(816) 795-8200

Fax

(816) 795-7735

NPI assigned

Jul 21, 2015

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Midwest Doctors Group, LLC

  dba Mid-America Sports Medicine and Wellness

  • Sports Medicine (Family Medicine) Physician
  • Independence, MO
  • NPI 1841462314
  NPD (past)

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

{
    "created_epoch": "1437436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447027200000",
    "number": "1144605098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19550 E 39TH ST S STE 230",
            "city": "INDEPENDENCE",
            "state": "MO",
            "postal_code": "640572309",
            "telephone_number": "816-795-8200",
            "fax_number": "816-795-7735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19550 E 39TH ST S STE 230",
            "city": "INDEPENDENCE",
            "state": "MO",
            "postal_code": "640572309",
            "telephone_number": "816-795-8200",
            "fax_number": "816-795-7735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STOLTMAN",
        "first_name": "TYLER",
        "credential": "ACT/LAT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-07-21",
        "last_updated": "2015-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MO",
            "license": "2013028788",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Benjamin Otto Stiles, D.C.
• Regina Louise Stillman
• Auburn E Stiner, RN
• Ruth A Stoan, LPC
• Brian E Stoltenberg, DPT
• Janda R Stone, DPT
• Melissa Joan Storms, ARNP,FNP-BC
• Carl N Stout Jr., MD
• Janelle Araceli Stout, SLPA
• William A Stout, CRNA

• Athletic Trainer in Independence, MO
• Providers in Independence, MO by specialty
• Athletic Trainer in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.