Individual provider Active NPI

Tyler Duane Little, PA-C

  • Physician Assistant
  • Canby, OR
National Provider Identifier
1407203144
Registry record updated Mar 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA185298 Issued in OR
Practice address
1433 SE 1St Ave
Canby, OR 97013-6768
Phone
(503) 525-7600
NPI assigned
May 23, 2016
Last updated
Mar 10, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 10, 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 PA185298 OR Primary
Medical Physician Assistant 363AM0700X PA185298 OR
Student in an Organized Health Care Education/Training Program 390200000X NU

Addresses

Primary practice location

1433 SE 1St Ave
Canby, OR 97013-6768

Mailing address

1233 Edgewater St NW
Salem, OR 97304-4049
Phone (503) 378-7526

Other practice location 1

4311 11th Ave NE
Suite 200
Seattle, WA 98105-6366
Phone (206) 616-4001

Other practice location 2

1233 Edgewater St NW
Salem, OR 97304-4049
Phone (503) 378-7526

Electronic endpoints 4

TypeEndpointUseAffiliation
Direct Messaging Address tlittle782813@oc.providencedirect.org
Direct Messaging Address tlittle782813@oc.providencedirect.org
Direct Messaging Address tlittle782813@oc.providencedirect.org
Direct Messaging Address tlittle782813@oc.providencedirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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 1

Enrollment IDStateProvider typePAC IDDetails
I20180119000197 OR Practitioner - Physician Assistant 0840559886 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Legacy Meridian Park HospitalGroup PAC ID 5092609842, 113 clinicians

Practice addresses (Care Compare)

1433 SE 1St Ave
Canby, OR 97013-6768
Phone (503) 525-7600

19300 SW 65TH Ave
Tualatin, OR 97062-7706
Phone (503) 413-4330

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Meridian Park Hospital CurrentSince Mar 10, 2025 Accepting new patients

Locations

1433 SE 1st Ave
Canby, OR 97013
Phone (503) 525-7600

1919 NW Lovejoy St
Portland, OR 97209
Phone (503) 415-5600

19300 SW 65th Ave
Tualatin, OR 97062
Phone (503) 692-1212

Organizations & group practices 1

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.

Hospital & facility affiliations 2

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": "1463961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741564800000",
    "number": "1407203144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1233 EDGEWATER ST NW",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973044049",
            "telephone_number": "503-378-7526",
            "fax_number": "503-588-5815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1433 SE 1ST AVE",
            "city": "CANBY",
            "state": "OR",
            "postal_code": "970136768",
            "telephone_number": "503-525-7600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4311 11th Ave NE",
            "address_2": "Suite 200",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981056366",
            "country_code": "US",
            "telephone_number": "206-616-4001",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1233 Edgewater St NW",
            "address_purpose": "LOCATION",
            "city": "Salem",
            "state": "OR",
            "postal_code": "973044049",
            "country_code": "US",
            "telephone_number": "503-378-7526",
            "fax_number": "503-588-5815",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LITTLE",
        "first_name": "TYLER",
        "middle_name": "DUANE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-23",
        "last_updated": "2025-03-10",
        "certification_date": "2025-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA185298",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OR",
            "license": "PA185298",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tlittle782813@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "200 S Hazel Dell Way",
            "city": "Canby",
            "state": "OR",
            "country_code": "US",
            "postal_code": "970137829",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tlittle782813@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "11995 SE Sunnyside Rd",
            "city": "Happy Valley",
            "state": "OR",
            "country_code": "US",
            "postal_code": "970159312",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tlittle782813@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "18040 SW Lower Boones Ferry Rd Ste 100",
            "city": "Tigard",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972247259",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tlittle782813@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "4816 NW Bethany Blvd",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972299254",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Canby, OR

Sources for this page

Verify at the official NPI Registry.