Active NPI
Tyler Wipf
- Physician Assistant
- San Diego, CA
National Provider Identifier
1437551074
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 3750 Convoy St Ste 116
San Diego, CA 92111-3739 - Phone
- (858) 292-1433
- NPI assigned
- Sep 25, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | WA | Primary |
Addresses
Primary practice location
3750 Convoy St Ste 116
San Diego, CA 92111-3739
Mailing address
3750 Convoy St Ste 116
San Diego, CA 92111-3739
Phone (858) 292-1433
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2039994 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| John G Lane, M.D. Inc | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Orthopaedic Surgery Physician
- San Diego, CA
- NPI 1780032847
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1411603200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1566259200000",
"number": "1437551074",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3750 CONVOY ST STE 116",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921113739",
"telephone_number": "858-292-1433"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3750 CONVOY ST STE 116",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921113739",
"telephone_number": "858-292-1433"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIPF",
"first_name": "TYLER",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-09-25",
"last_updated": "2019-08-20",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WA",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2039994",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2019; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.