NPIMap

Individual provider Active NPI

Tylan Wayne Magnusson, MD

  • Internal Medicine Physician
  • Birmingham, AL
National Provider Identifier
1437619517
Registry record updated Aug 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
41817 Issued in AL
Practice address
NP 2540
1720 2ND Avenue South
Birmingham, AL 35294-3300
Phone
(205) 933-8101
Fax
(205) 934-9573
NPI assigned
Mar 23, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 41817 AL Primary

Addresses

Primary practice location

NP 2540
1720 2ND Avenue South
Birmingham, AL 35294-3300

Mailing address

625 19TH St South
Birmingham, AL 35249-1900
Phone (205) 934-2490

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
I20250702002355 ID Practitioner - Hematology/Oncology 5395087951 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Hematology/Oncology
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Utah Cancer Specialists PCGroup PAC ID 1355254749, 48 clinicians
Madison Memorial HospitalGroup PAC ID 4183949522, 20 clinicians

Practice addresses (Care Compare)

3100 Channing Way
Idaho Falls, ID 83404-7533
Phone (208) 529-6111

3245 Channing Way
Idaho Falls, ID 83404-7536
Phone (801) 262-9494

450 E Main St
Reburg, ID 83440-2048
Phone (208) 359-6516

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
41817ALMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Madison Memorial Hospital CurrentSince Jan 13, 2026 Accepting new patients
Utah Cancer Specialists PC Hematology & Oncology CurrentSince Jun 24, 2025 Accepting new patients
Utah Cancer Specialists PC Hematology & Oncology PastSince Nov 30, 2025 Accepting new patients
BMH Inc. Past Accepting new patients

Locations

3245 Channing Way
Idaho Falls, ID 83404
Phone (208) 227-2700

450 E Main St
Rexburg, ID 83440
Phone (208) 356-3691

10808 S River Front Pkwy
Ste 400
South Jordan, UT 84095

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/d61ab3e4-55bb-4859-99e6-22c413b48f2a/

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 and National Provider Directory roles.

Hospital & facility affiliations 9

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": "1553299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692576000000",
    "number": "1437619517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 19TH ST SOUTH",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352491900",
            "telephone_number": "205-934-2490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "NP 2540",
            "address_2": "1720 2ND AVENUE SOUTH",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352943300",
            "telephone_number": "205-933-8101",
            "fax_number": "205-934-9573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAGNUSSON",
        "first_name": "TYLAN",
        "middle_name": "WAYNE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-23",
        "last_updated": "2023-08-21",
        "certification_date": "2023-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "AL",
            "license": "41817",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Birmingham, AL

Sources for this page

Verify at the official NPI Registry.