Individual provider Active NPI

Tyler Jeffrey Mize, PA-C

  • Physician Assistant
  • Wildwood, FL
National Provider Identifier
1457901530
Registry record updated Oct 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9112561 Issued in FL
Practice address
5575 E Sr 44
Wildwood, FL 34785-8282
Phone
(352) 571-4418
NPI assigned
Sep 19, 2019
Last updated
Oct 11, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9112561 FL Primary
Medical Physician Assistant 363AM0700X NU

Addresses

Primary practice location

5575 E Sr 44
Wildwood, FL 34785-8282

Mailing address

2009 N Lakecrest Loop
Hernando, FL 34442-6259
Phone (423) 505-7540

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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
I20240103001547 TN Practitioner - Physician Assistant 6901138379 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Health System, Inc.Group PAC ID 5294646378, 512 clinicians

Practice addresses (Care Compare)

1924 Alcoa Hwy
Knoxville, TN 37920-1511

1940 Alcoa Hwy
Knoxville, TN 37920-2263
Phone (865) 305-6810

1940 Alcoa Hwy E 260
Knoxville, TN 37920-2263
Phone (865) 524-7471

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.48 of 100Reported as apm
Quality
86.23
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5789TNMDSpeech-Language Pathologist
PA9112561FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
University Health System Inc CurrentSince Dec 1, 2023 Accepting new patients
University Health System, Inc CurrentSince Dec 1, 2023 Accepting new patients
Knoxville Neurology Specialists, PLLC Past Accepting new patients

Locations

1940 Alcoa Hwy
Ste E260
Knoxville, TN 37920
Phone (865) 305-6955

9000 Executive Park Dr
Ste C200
Knoxville, TN 37923
Phone (865) 670-6142

Organizations & group practices 4

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 1

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": "1568851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696982400000",
    "number": "1457901530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2009 N LAKECREST LOOP",
            "city": "HERNANDO",
            "state": "FL",
            "postal_code": "344426259",
            "telephone_number": "423-505-7540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5575 E SR 44",
            "city": "WILDWOOD",
            "state": "FL",
            "postal_code": "347858282",
            "telephone_number": "352-571-4418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIZE",
        "first_name": "TYLER",
        "middle_name": "JEFFREY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-09-19",
        "last_updated": "2023-10-11",
        "certification_date": "2023-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9112561",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wildwood, FL

Sources for this page

Verify at the official NPI Registry.