Individual provider Active NPI

Tyler Southard, PA-C

  • Physician Assistant
  • Medford, OR
National Provider Identifier
1457755134
Registry record updated Oct 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
2780 E Barnett Rd Ste 200
Medford, OR 97504-8674
Phone
(541) 779-6250
Fax
(541) 608-2535
NPI assigned
Oct 9, 2014
Last updated
Oct 5, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 5, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X OR Primary

Addresses

Primary practice location

2780 E Barnett Rd Ste 200
Medford, OR 97504-8674

Mailing address

2780 E Barnett Rd Ste 200
Medford, OR 97504-8674
Phone (541) 779-6250

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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

Enrollment IDStateProvider typePAC IDDetails
I20191002002696 OR Practitioner - Physician Assistant 8123358256 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern Oregon Orthopedics IncGroup PAC ID 1456256528, 64 clinicians
Advanced Joint Replacement Center LLCGroup PAC ID 3779972161, 11 clinicians

Practice addresses (Care Compare)

2780 E Barnett Rd
Suite 200
Medford, OR 97504-8674
Phone (541) 779-6250

707 Murphy Rd
Medford, OR 97504-8520
Phone (541) 622-8900

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
79.72 of 100Reported as group
Quality
71.87
Promoting interoperability
76
Improvement activities
40
Cost
80.52

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Joint Replacement Center LLC CurrentSince Feb 1, 2026 Accepting new patients
Southern Oregon Orthopedics Inc Physician Assistant CurrentSince Sep 1, 2019 Accepting new patients

Locations

2780 E Barnett Rd
Ste 200
Medford, OR 97504
Phone (541) 779-6250

707 Murphy Rd
Medford, OR 97504
Phone (541) 622-8900

Interoperability endpoints

  • Direct secure messaging: tsouthard1150136@oc.providencedirect.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

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": "1412812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664928000000",
    "number": "1457755134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2780 E BARNETT RD STE 200",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048674",
            "telephone_number": "541-779-6250",
            "fax_number": "541-608-2535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2780 E BARNETT RD STE 200",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "975048674",
            "telephone_number": "541-779-6250",
            "fax_number": "541-608-2535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUTHARD",
        "first_name": "TYLER",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-10-09",
        "last_updated": "2022-10-05",
        "certification_date": "2022-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medford, OR

Sources for this page

Verify at the official NPI Registry.