Justin Tyler Tidwell, DNP, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

95000691 Issued in CA

Practice address

300 Pasteur Dr
Stanford, CA 94305-2200

Phone

(650) 723-4000

NPI assigned

Jul 26, 2014

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

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Stanford Health CareGroup PAC ID 6709797491, 3,152 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Stanford Health Care Hospital, Stanford, CA, CCN 050441

Merit-based Incentive Payment System (MIPS)

Final score

88.53 of 100Reported as group

Quality

87.08

Promoting interoperability

100

Improvement activities

40

Cost

69.51

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Stanford Health Care

  • General Acute Care Hospital
  • Stanford, CA
  • NPI 1437292927
  Medicare reassignment Care Compare group NPD
• LPCH Medical Group Div of Lucile

  • Children's Hospital
  • Palo Alto, CA
  • NPI 1417907940
  Medicare reassignment NPD
• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Santa Clara, CA
  • NPI 1073606299
  Medicare reassignment NPD
• Sutter Bay Hospitals

  • General Acute Care Hospital
  • Santa Rosa, CA
  • NPI 1740413798
  Medicare reassignment NPD
• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Stockton, CA
  • NPI 1548343510
  NPD
• Permanente Medical Group, Inc

  • Clinical Medical Laboratory
  • San Jose, CA
  • NPI 1497971584
  NPD
• Stanford Health Care

  • General Acute Care Hospital
  • Emeryville, CA
  • NPI 1275076325
  NPD
• Stanford Health Care

  • Specialty Pharmacy
  • Mountain View, CA
  • NPI 1760366132
  NPD
• Sutter Bay Hospitals

  • Rehabilitation Hospital Unit
  • Oakland, CA
  • NPI 1194171371
  NPD
• Sutter Bay Hospitals

  • General Acute Care Hospital
  • San Francisco, CA
  • NPI 1730238007
  NPD

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

• Stanford Health Care

  • Radiation Oncology Physician
  • Pleasanton, CA
  • NPI 1124561758

  Hospital

  Care Compare affiliation
• Stanford Health Care

  • General Acute Care Hospital
  • Emeryville, CA
  • NPI 1275076325
  Care Compare affiliation
• Stanford Health Care

  • General Acute Care Hospital
  • Emeryville, CA
  • NPI 1285177337
  Care Compare affiliation
• Stanford Health Care

  • General Acute Care Hospital
  • Stanford, CA
  • NPI 1437292927
  Care Compare affiliation
• Stanford Health Care

  • General Acute Care Hospital
  • Pleasanton, CA
  • NPI 1467990465
  Care Compare affiliation
• Stanford Health Care

  • General Acute Care Hospital
  • Stanford, CA
  • NPI 1871543215
  Care Compare affiliation
• Stanford Life Flight

  • Air Ambulance
  • Stanford, CA
  • NPI 1114063203

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1406332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730851200000",
    "number": "1245648922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 PASTEUR DR",
            "city": "STANFORD",
            "state": "CA",
            "postal_code": "943052200",
            "telephone_number": "650-723-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 PASTEUR DR",
            "city": "STANFORD",
            "state": "CA",
            "postal_code": "943052200",
            "telephone_number": "650-723-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2333 Buchanan St",
            "address_purpose": "LOCATION",
            "city": "San Francisco",
            "state": "CA",
            "postal_code": "941151925",
            "country_code": "US",
            "telephone_number": "415-600-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TIDWELL",
        "first_name": "JUSTIN",
        "middle_name": "TYLER",
        "credential": "DNP, NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-26",
        "last_updated": "2024-11-06",
        "certification_date": "2024-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "CA",
            "license": "95000691",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95000691",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "2238 Geary Blvd",
            "city": "San Francisco",
            "state": "CA",
            "country_code": "US",
            "postal_code": "941153416",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Elizabeth Dilip Thottacherry, MD
• Zachary David Threlkeld, MD
• Myaing Soe Thu, PHYSICAL THERAPIST
• Jonathan R Tiao
• Nancy Wen-Hsing Tibbs, MD
• Vivian Tien, MD
• Kathleen Tillmanns-Mossotti, NP
• Hemali Vijay Tilva, MD
• Garrett Malloy Timmons, MD
• Tabitha Chung-Yan Ting, MD

• Nurse Practitioner in Stanford, CA
• Providers in Stanford, CA by specialty
• Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 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.