Tyler Grant Waldron, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

53447 Issued in CA

Practice address

26401 Crown Valley Pkwy
Ste 101
Mission Viejo, CA 92691-6302

Phone

(949) 348-4000

Fax

(949) 348-7466

NPI assigned

Jun 7, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

Physician Assistant

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Community Orthopedic Medical GroupGroup PAC ID 2365426517, 17 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence Mission Hospital Hospital, Mission Viejo, CA, CCN 050567

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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.

• Community Orthopedic Medical Group

  • Orthopaedic Surgery Physician
  • Mission Viejo, CA
  • NPI 1508823873
  Medicare reassignment Care Compare group

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Mission Hospital Regional Medical Center

  dba Providence Mission Hospital

  • General Acute Care Hospital
  • Mission Viejo, CA
  • NPI 1912108002
  Care Compare affiliation
• Mission Hospital Regional Medical Center

  dba Mission Hospital

  • General Acute Care Hospital
  • Mission Viejo, CA
  • NPI 1992752315
  Care Compare affiliation

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

{
    "created_epoch": "1465257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465257600000",
    "number": "1407205875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26401 CROWN VALLEY PKWY",
            "address_2": "STE 101",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926916302",
            "telephone_number": "949-348-4000",
            "fax_number": "949-348-7466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26401 CROWN VALLEY PKWY",
            "address_2": "STE 101",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926916302",
            "telephone_number": "949-348-4000",
            "fax_number": "949-348-7466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALDRON",
        "first_name": "TYLER",
        "middle_name": "GRANT",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-07",
        "last_updated": "2016-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "53447",
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CA",
            "license": "53447",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathleen Wachter, COTA
• Chad Allen Wadell, M.D.
• Stacy Wagner
• Barbara Wainer, SLPA
• Jerald P Waldman, MD
• Walgreen Co (Walgreens #09843)
• Walgreen Co (Walgreens Specialty Pharmacy #21195)
• Paula Walker
• Patricia A Wallace, MD
• Amanda Marie Wallin

• Physician Assistant in Mission Viejo, CA
• Providers in Mission Viejo, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2016; 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.

Verify at the official NPI Registry.