Individual provider Active NPI

Tyler Amores, DMSC, PA-C

  • Physician Assistant
  • Bingham Farms, MI
National Provider Identifier
1356901474
Registry record updated Feb 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601011184 Issued in MI
Practice address
30300 Telegraph Rd Ste 310
Bingham Farms, MI 48025-5822
Phone
(248) 468-1889
NPI assigned
Jun 20, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Physician Assistant 363A00000X 5601011184 MI Primary

Addresses

Primary practice location

30300 Telegraph Rd Ste 310
Bingham Farms, MI 48025-5822

Mailing address

28475 Greenfield Rd
Ste 113 PMB 11918
Southfield, MI 48076
Phone (248) 230-9660

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
5601011184MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Cielo Medica Current Accepting new patients
Integrative Psychiatry Services PC PastSince Dec 13, 2022 Accepting new patients

Locations

28475 Greenfield Rd
Ste 113
Southfield, MI 48076
Phone (248) 230-9660

Organizations & group practices 2

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": "1560988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675382400000",
    "number": "1356901474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28475 GREENFIELD RD",
            "address_2": "STE 113 PMB 11918",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "48076",
            "telephone_number": "248-230-9660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30300 TELEGRAPH RD STE 310",
            "city": "BINGHAM FARMS",
            "state": "MI",
            "postal_code": "480255822",
            "telephone_number": "248-468-1889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMORES",
        "first_name": "TYLER",
        "credential": "DMSC, PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-20",
        "last_updated": "2023-02-03",
        "certification_date": "2023-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601011184",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bingham Farms, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.