Individual provider Active NPI

Stephanie Renee Tyo, MD

  • Family Medicine Physician
  • Tyler, TX
National Provider Identifier
1417277435
Registry record updated Jan 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
30198 Issued in WV
Practice address
13172 State Highway 64 E
Tyler, TX 75707-5340
Phone
(903) 535-9041
Fax
(903) 630-6740
NPI assigned
Jun 2, 2010
Last updated
Jan 5, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 30198 WV Primary

Addresses

Primary practice location

13172 State Highway 64 E
Tyler, TX 75707-5340

Mailing address

523 S Fannin Ave
Tyler, TX 75702-8204
Phone (903) 535-9041

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, WV2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20130906000371 TX Practitioner - Family PracticePractitioner - General Practice 2062655277 Reassigns benefits to 1 organization
I20210413002457 WV Practitioner - Family Practice 2062655277 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
West Virginia University School of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tyler Family Circle of CareGroup PAC ID 4587812888, 28 clinicians

Practice addresses (Care Compare)

13172 State Hwy 64 E
Tyler, TX 75707-5340
Phone (903) 606-2212

Merit-based Incentive Payment System (MIPS)

Final score
90.94 of 100Reported as apm
Quality
69.71
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
30198WVMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cabin Creek Health Center, Inc. CurrentSince Apr 8, 2021 Accepting new patients
Cabin Creek Health Center, Inc. CurrentSince Apr 8, 2021 Accepting new patients
Goodside Health Medical, PLLC PastSince May 9, 2025 Accepting new patients
Tyler Family Circle of Care PastSince Jan 19, 2025 Accepting new patients

Locations

1 Warrior Way
Ste 103
Belle, WV 25015
Phone (304) 949-3591

104 Alex Ln
Charleston, WV 25304
Phone 30473420401319

107 Koontz Ave
Ste 200
Clendenin, WV 25045
Phone (304) 548-7272

Interoperability endpoints

  • Direct secure messaging: stephanie.tyo.1@7267.direct.athenahealth.com
  • Direct secure messaging: styo584372@christushealth.direct-ci.net

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": "1275436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1767571200000",
    "number": "1417277435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "523 S FANNIN AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757028204",
            "telephone_number": "903-535-9041",
            "fax_number": "903-630-2039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13172 STATE HIGHWAY 64 E",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757075340",
            "telephone_number": "903-535-9041",
            "fax_number": "903-630-6740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TYO",
        "first_name": "STEPHANIE",
        "middle_name": "RENEE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-02",
        "last_updated": "2026-01-05",
        "certification_date": "2026-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WV",
            "license": "30198",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

Verify at the official NPI Registry.