Individual provider Active NPI

Ty Joo McComas, FNP-C

  • Family Nurse Practitioner
  • Ogden, UT
National Provider Identifier
1164813184
Registry record updated Feb 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4917488-4405 Issued in UT
Practice address
2240 Adams Ave
Ogden, UT 84401-1511
Phone
(801) 393-5355
Fax
(801) 934-4609
NPI assigned
Feb 12, 2015
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 3, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X APRN-1854 HI
Family Nurse Practitioner 363LF0000X 4917488-4405 UT Primary

Addresses

Primary practice location

2240 Adams Ave
Ogden, UT 84401-1511

Mailing address

2240 Adams Ave
Ogden, UT 84401-1511
Phone (801) 393-5355

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
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

Enrollment IDStateProvider typePAC IDDetails
I20200921001725 UT Practitioner - Nurse Practitioner 3678884517 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2240 Adams Ave
Ogden, UT 84401-1511
Phone (801) 393-5355

781 25TH St
Ogden, UT 84401-2509
Phone (801) 622-1451

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
APRN-1854HIMDFamily Nurse Practitioner
4917488-4405UTMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Midtown Community Health Center Inc CurrentSince Jun 6, 2020 Accepting new patients
Midtown Community Health Center Inc CurrentSince Jun 6, 2020 Accepting new patients
Molokai Ohana Health Care, Inc. PastSince Nov 16, 2021 Accepting new patients
Midtown Community Health Center Inc Past Accepting new patients

Locations

22 S State St
Ste 1007
Clearfield, UT 84015
Phone (801) 334-0030

781 25th St
Ogden, UT 84401
Phone (801) 622-1451

2240 Adams Ave
Ogden, UT 84401
Phone (801) 393-5355

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1423699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770076800000",
    "number": "1164813184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2240 ADAMS AVE",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844011511",
            "telephone_number": "801-393-5355",
            "fax_number": "801-394-4609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2240 ADAMS AVE",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844011511",
            "telephone_number": "801-393-5355",
            "fax_number": "801-934-4609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCOMAS",
        "first_name": "TY",
        "middle_name": "JOO",
        "name_prefix": "Mr.",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-02-12",
        "last_updated": "2026-02-03",
        "certification_date": "2026-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "HI",
            "license": "APRN-1854",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "UT",
            "license": "4917488-4405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ogden, UT

Sources for this page

Verify at the official NPI Registry.