Individual provider Active NPI

Tyler Anthony Vitus, PA-C

  • Physician Assistant
  • Cleveland, OH
National Provider Identifier
1174386841
Registry record updated Sep 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50.009387RX Issued in OH
Practice address
9500 Euclid Ave
Cleveland, OH 44195-2567
Phone
(216) 444-2200
NPI assigned
Feb 5, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 50.009387RX OH Primary

Addresses

Primary practice location

9500 Euclid Ave
Cleveland, OH 44195-2567

Mailing address

79 Planted Pine Dr
Purvis, MS 39475-5518
Phone (330) 717-1736

Other practice location 1

950 Matthew Dr
Waynesboro, MS 39367-2567
Phone (601) 735-5500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS, OH2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20240312000479 MS Practitioner - Physician Assistant 3375989452
I20250527001651 OH Practitioner - Physician Assistant 3375989452 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
50.009387RXOHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Complexcare Medical Group Midwest M PLLC Physician Assistant CurrentSince Aug 2, 2025 Accepting new patients
The Cleveland Clinic Foundation CurrentSince Apr 16, 2025 Accepting new patients
Theoria Medical Physician Assistant CurrentSince Aug 2, 2025 Accepting new patients
The Cleveland Clinic Foundation CurrentSince Apr 16, 2025 Accepting new patients

Locations

41800 W 11 Mile Rd
Novi, MI 48375
Phone (248) 282-5044

41800 W 11 Mile Rd
Ste 109
Novi, MI 48375
Phone (833) 578-2763

33300 Cleveland Clinic Blvd
Avon, OH 44011
Phone (440) 686-0105

18101 Lorain Ave
Cleveland, OH 44111
Phone (216) 476-7029

9500 Euclid Ave
Cleveland, OH 44195
Phone (216) 442-1270

18901 Lake Shore Blvd
Euclid, OH 44119
Phone (216) 531-9000

6780 Mayfield Rd
Mayfield Hts, OH 44124
Phone (440) 331-9520

6801 Brecksville Rd
Ste 20
Seven Hills, OH 44131
Phone (216) 445-3363

7120 Port Sylvania Dr
Toledo, OH 43617
Phone (419) 841-2200

1030 High St
Worthington, OH 43085
Phone (614) 876-7356

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": "1707091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758067200000",
    "number": "1174386841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "79 PLANTED PINE DR",
            "city": "PURVIS",
            "state": "MS",
            "postal_code": "394755518",
            "telephone_number": "330-717-1736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9500 EUCLID AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441952567",
            "telephone_number": "216-444-2200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "950 Matthew Dr",
            "address_purpose": "LOCATION",
            "city": "Waynesboro",
            "state": "MS",
            "postal_code": "393672567",
            "country_code": "US",
            "telephone_number": "601-735-5500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VITUS",
        "first_name": "TYLER",
        "middle_name": "ANTHONY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-02-05",
        "last_updated": "2025-09-17",
        "certification_date": "2025-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.009387RX",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, OH

Sources for this page

Verify at the official NPI Registry.