NPIMap

Organization Active NPI

Tyler G. Smith, MD. a Professional Corporation

  • Orthopaedic Surgery of the Spine Physician
  • Roseville, CA
National Provider Identifier
1356856538
Registry record updated Mar 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery of the Spine PhysicianTaxonomy code 207XS0117X
License
A108880 Issued in CA
Legal business name
TYLER G. SMITH, MD. A PROFESSIONAL CORPORATION
Practice address
5 Medical Plaza Dr Ste 120
Roseville, CA 95661-2866
Phone
(916) 352-0016
Fax
(916) 299-0032
NPI assigned
Dec 9, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2024

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

Authorized official

Name
Tyler G Smith, MDNPI 1386650802
Title
Ceo
Phone
(916) 352-0016

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery of the Spine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207XS0117X A108880 CA Primary

Addresses

Primary practice location

5 Medical Plaza Dr Ste 120
Roseville, CA 95661-2866

Mailing address

5 Medical Plaza Dr Ste 120
Roseville, CA 95661-2866
Phone (916) 352-0016

Other identifiers 1

IdentifierTypeStateIssuer
A108880OtherCALICENSE NUMBER

Other names 1

  • Sierra Spine Institute Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20180226001295 CA Part B Supplier - Clinic/Group Practice 4688935109 Receives reassigned benefits from 5 practitioners
Practice locations: Roseville, CA
O20180827000451 CA DME Supplier - Physician - Orthopedic/Orthopedic Surgery 4688935109 Practice locations: Roseville, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1512777600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710201600000",
    "number": "1356856538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 MEDICAL PLAZA DR STE 120",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956612866",
            "telephone_number": "916-352-0016",
            "fax_number": "916-299-0032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 MEDICAL PLAZA DR STE 120",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956612866",
            "telephone_number": "916-352-0016",
            "fax_number": "916-299-0032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TYLER G. SMITH, MD. A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-09",
        "last_updated": "2024-03-12",
        "certification_date": "2024-03-12",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "TYLER",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "916-352-0016",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207XS0117X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Orthopaedic Surgery, Orthopaedic Surgery of the Spine",
            "state": "CA",
            "license": "A108880",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "A108880",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sierra Spine Institute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Roseville, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.