Individual provider Active NPI

Tyler Douglas Merrill, PA-C

  • Physician Assistant
  • Richland, WA
National Provider Identifier
1366172603
Registry record updated May 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA61662540 Issued in WA
Practice address
875 Swift Blvd Ste a
Richland, WA 99352-3513
Phone
(509) 946-1654
Fax
(509) 943-5652
NPI assigned
Jun 10, 2022
Last updated
May 6, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 6, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 12762056-1206 UT
Physician Assistant 363A00000X PA61662540 WA Primary
Medical Physician Assistant 363AM0700X NU

Addresses

Primary practice location

875 Swift Blvd Ste a
Richland, WA 99352-3513

Mailing address

550 Gage Blvd Ste 101
Richland, WA 99352-9532
Phone (509) 473-0637

Other practice location 1

2825 E Mall Dr
St George, UT 84790-1954
Phone (435) 628-9393

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address medreview@reverehealth.com Central Utah Clinic, P.C.

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT, WA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20220706003239 UT Practitioner - Physician Assistant 1355721499 Reassigns benefits to 1 organization
I20250514000841 WA Practitioner - Physician Assistant 1355721499 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kadlec Regional Medical CenterGroup PAC ID 9739098617, 402 clinicians

Practice addresses (Care Compare)

1135 Jadwin Ave
Richland, WA 99352-3434
Phone (509) 942-3300

875 Swift Blvd
Suite a
Richland, WA 99352-3592
Phone (509) 946-1654

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
12762056-1206UTMDPhysician Assistant
PA61662540WAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Revere Health PC CurrentSince Jun 15, 2022 Accepting new patients
Kadlec Regional Medical Center CurrentSince May 1, 2025 Accepting new patients
Kadlec Regional Medical Center CurrentSince May 1, 2025 Accepting new patients
Revere Health PC CurrentSince Jun 15, 2022 Accepting new patients
Kadlec Regional Medical Center Past Accepting new patients

Locations

1055 N 500 W
Provo, UT 84604
Phone (801) 429-8000

1055 N 500 W
Ste 212
Provo, UT 84604
Phone (801) 374-2362

2825 E Mall Dr
St George, UT 84790
Phone (435) 673-6131

1135 Jadwin Ave
Richland, WA 99352
Phone (509) 942-3300

550 Gage Blvd
Ste 101
Richland, WA 99352

875 Swift Blvd
Ste A
Richland, WA 99352
Phone (509) 942-2573

888 Swift Blvd
Richland, WA 99352
Phone (509) 942-2115

Interoperability endpoints

  • Direct secure messaging: tmerrill3790823@wm.providencedirect.org

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1654819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746489600000",
    "number": "1366172603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 GAGE BLVD STE 101",
            "city": "RICHLAND",
            "state": "WA",
            "postal_code": "993529532",
            "telephone_number": "509-473-0637",
            "fax_number": "509-627-2983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "875 SWIFT BLVD STE A",
            "city": "RICHLAND",
            "state": "WA",
            "postal_code": "993523513",
            "telephone_number": "509-946-1654",
            "fax_number": "509-943-5652"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2825 E Mall Dr",
            "address_purpose": "LOCATION",
            "city": "St George",
            "state": "UT",
            "postal_code": "847901954",
            "country_code": "US",
            "telephone_number": "435-628-9393",
            "fax_number": "435-628-9382",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MERRILL",
        "first_name": "TYLER",
        "middle_name": "DOUGLAS",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-06-10",
        "last_updated": "2025-05-06",
        "certification_date": "2025-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "12762056-1206",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA61662540",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "medreview@reverehealth.com",
            "affiliation": "Y",
            "affiliationName": "Central Utah Clinic, P.C.",
            "address_1": "2825 E Mall Dr",
            "city": "St George",
            "state": "UT",
            "country_code": "US",
            "postal_code": "847901954",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Richland, WA

Sources for this page

Verify at the official NPI Registry.