Tyler John Southwell, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

47542 Issued in AZ

Practice address

10599 N Tatum Blvd Ste F151
Paradise Valley, AZ 85253-1053

Phone

(480) 991-9271

Fax

(844) 284-7758

NPI assigned

Jul 27, 2008

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

Medicare fee-for-service enrollment

Enrolled in AZ

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 Practice

Education

Wayne State University School of Medicine, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/23931/brand/1/csg/1/fhir/r4
• Direct secure messaging: tyler.southwell.1@23931.direct.athenahealth.com

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.

• Southwellness Medical LLC

  • Family Medicine Physician
  • Paradise Valley, AZ
  • NPI 1366099533
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1217116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611619200000",
    "number": "1194980367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6033 E CARNATION CIR",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850186716",
            "telephone_number": "616-560-4160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10599 N TATUM BLVD STE F151",
            "city": "PARADISE VALLEY",
            "state": "AZ",
            "postal_code": "852531053",
            "telephone_number": "480-991-9271",
            "fax_number": "844-284-7758"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUTHWELL",
        "first_name": "TYLER",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-07-27",
        "last_updated": "2021-01-26",
        "certification_date": "2021-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301095075",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "47542",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sigalove Aesthetics LLC
• Sina. Inc
• Peter J Smith, D.C.,
• William Smith Jr., MD
• Emily Broghan Schutsky Snyder, NP
• Southwellness Medical LLC
• Southwest Iom Pro LLC
• Southwest Iom, LLC
• Jerry Preston Sparks, DDS
• Speech America Learning Associate, Inc.

• Family Medicine Physician in Paradise Valley, AZ
• Providers in Paradise Valley, AZ by specialty
• Family Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2021; 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.