NPIMap

Individual provider Active NPI

Tyler Waddington Hudon, MD, MPH

  • Family Medicine Physician
  • Meridian, ID
National Provider Identifier
1295097012
Registry record updated Jul 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
M-12244 Issued in ID
Practice address
3280 E Lanark Dr
Meridian, ID 83642-5982
Phone
(208) 895-8670
Fax
(208) 955-0494
NPI assigned
Jun 8, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MRM-1262 ID
Family Medicine Physician 207Q00000X M-12244 ID Primary

Addresses

Primary practice location

3280 E Lanark Dr
Meridian, ID 83642-5982

Mailing address

PO Box 191050
Boise, ID 83719-1050
Phone (208) 955-6500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140618001344 ID Practitioner - Family Practice 2567692486 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Connecticut School of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Alliance Medical Group LLCGroup PAC ID 3971544685, 132 clinicians

Practice addresses (Care Compare)

3280 E Lanark Dr
Meridian, ID 83642-5982
Phone (208) 895-8670

Hospital & facility affiliations

  • Horizon Home Health Home health agency, Meridian, ID, CCN 137065
  • St Luke'S Regional Medical Center Hospital, Boise, ID, CCN 130006
  • Saint Alphonsus Regional Medical Center Hospital, Boise, ID, CCN 130007

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
M-12244IDMDFamily Medicine Physician
MRM-1262IDMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Alliance Medical Group, LLC Family Medicine CurrentSince May 21, 2014 Accepting new patients
Alliance Medical Group, LLC Family Medicine CurrentSince May 21, 2014 Accepting new patients
Alliance Medical Group, LLC Family Medicine Past Accepting new patients

Locations

10482 W Carlton Bay Dr
Garden City, ID 83714
Phone (208) 454-9690

3115 E Florence Dr
Meridian, ID 83642
Phone (208) 378-4288

3280 E Lanark Dr
Meridian, ID 83642
Phone (208) 377-4400

Interoperability endpoints

  • Direct secure messaging: tyler.hudon@phmg.eclinicaldirectplus.com

Organizations & group practices 3

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.

Hospital & facility affiliations 8

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

NPI Registry JSON

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

{
    "created_epoch": "1339113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626134400000",
    "number": "1295097012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 191050",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837191050",
            "telephone_number": "208-955-6500",
            "fax_number": "208-955-6503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3280 E LANARK DR",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836425982",
            "telephone_number": "208-895-8670",
            "fax_number": "208-955-0494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUDON",
        "first_name": "TYLER",
        "middle_name": "WADDINGTON",
        "credential": "MD, MPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-08",
        "last_updated": "2021-07-13",
        "certification_date": "2021-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "MRM-1262",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "ID",
            "license": "M-12244",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Meridian, ID

Sources for this page

Verify at the official NPI Registry.