NPIMap

Individual provider Active NPI

Tyler Howard Buckley, M.D.

  • Hematology & Oncology Physician
  • Lewiston, ID
National Provider Identifier
1407299522
Registry record updated Dec 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
M-16466 Issued in ID
Practice address
1250 Idaho St
Lewiston, ID 83501-1965
Phone
(208) 743-7427
NPI assigned
Apr 8, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X MD60942112 WA
Hematology & Oncology Physician 207RH0003X M-16466 ID Primary

Addresses

Primary practice location

1250 Idaho St
Lewiston, ID 83501-1965

Mailing address

1250 Idaho St
Lewiston, ID 83501-1965
Phone (208) 743-7427

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220324000793 ID Practitioner - Medical Oncology 0244553048 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Medical Oncology
Education
University of Tennessee, HSC, College of Medicine, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Joseph Hospital LLCGroup PAC ID 8325325806, 91 clinicians

Practice addresses (Care Compare)

307 Saint Johns Way
Suite 1
Lewiston, ID 83501-2435
Phone (208) 743-3998

415 6TH St
Lewiston, ID 83501-2431

821 21St Ave
Lewiston, ID 83501-6389
Phone (208) 799-3422

Hospital & facility affiliations

  • St Joseph Regional Medical Center Hospital, Lewiston, ID, CCN 130003
  • Clearwater Valley Hospital & Clinics Hospital, Orofino, ID, CCN 131320
  • St Mary'S Hospital Hospital, Cottonwood, ID, CCN 131321
  • Syringa General Hospital Hospital, Grangeville, ID, CCN 131315
  • Gritman Medical Center Hospital, Moscow, ID, CCN 131327

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
M-16466IDMDHematology & Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Joseph Hospital LLC CurrentSince Mar 1, 2022 Accepting new patients
St. Joseph Hospital LLC Past Accepting new patients

Locations

821 21st Ave
Lewiston, ID 83501
Phone (208) 799-3422

341 Saint Johns Way
Lewiston, ID 83501
Phone (208) 750-7462

307 Saint Johns Way
Ste 11
Lewiston, ID 83501
Phone (208) 743-7612

1250 Idaho St
Lewiston, ID 83501
Phone (208) 743-7427

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.

Hospital & facility affiliations 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1365379200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735257600000",
    "number": "1407299522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1250 IDAHO ST",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835011965",
            "telephone_number": "208-743-7427",
            "fax_number": "208-743-7421"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 IDAHO ST",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835011965",
            "telephone_number": "208-743-7427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUCKLEY",
        "first_name": "TYLER",
        "middle_name": "HOWARD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-08",
        "last_updated": "2024-12-27",
        "certification_date": "2024-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "WA",
            "license": "MD60942112",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "ID",
            "license": "M-16466",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lewiston, ID

Sources for this page

Verify at the official NPI Registry.