Active NPI
Tyler Douglas Merrill, PA-C
- Physician Assistant
- Richland, WA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA61662540
- 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, 2025
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | medreview@reverehealth.com | Central Utah Clinic, P.C. |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in UT, WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 2
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
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
| License | State | Type | Specialty |
|---|---|---|---|
| 12762056-1206 | UT | MD | Physician Assistant |
| PA61662540 | WA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Revere Health PC | Current | Accepting new patients | |
| Kadlec Regional Medical Center | Current | Accepting new patients | |
| Kadlec Regional Medical Center | Current | Accepting new patients | |
| Revere Health PC | Current | 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
- 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.
-
- General Acute Care Hospital
- Richland, WA
- NPI 1972507580
-
- Plastic Surgery Physician
- Richland, WA
- NPI 1235471954
-
dba Kadlec Regional Medical Center - Rehab Unit
- Rehabilitation Hospital Unit
- Richland, WA
- NPI 1790319580
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2025; 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.