Individual provider Active NPI

Trey Nygren, PA-C

  • Physician Assistant
  • Buffalo, IA
National Provider Identifier
1467122242
Registry record updated Sep 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
108364 Issued in IA
Practice address
1105 Hacker St
Buffalo, IA 52728-7776
Phone
(308) 233-2353
NPI assigned
Sep 14, 2021
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 14, 2021

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 085.008287 IL
Physician Assistant 363A00000X 108364 IA Primary

Addresses

Primary practice location

1105 Hacker St
Buffalo, IA 52728-7776

Mailing address

1105 Hacker St
Buffalo, IA 52728-7776
Phone (308) 233-2353

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA, IL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20211203001479 IA Practitioner - Physician Assistant 2062802150 Reassigns benefits to 1 organization
I20211211000071 IL Practitioner - Physician Assistant 2062802150 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1417 Kimberly Rd
Bettendorf, IA 52722-4131
Phone (563) 949-4503

4480 Utica Ridge Rd
Bettendorf, IA 52722-1644

5185 Competition Dr
Bettendorf, IA 52722-8833
Phone (563) 888-5660

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
108364IAMDPhysician Assistant
085.008287ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Iowa Physicians Clinic Medical Foundation Physician Assistant CurrentSince Dec 6, 2021 Accepting new patients
St Luke'S Methodist Hospital Current Accepting new patients
Iowa Physicians Clinic Medical Foundation CurrentSince Dec 6, 2021 Accepting new patients

Locations

4480 Utica Ridge Rd
Ste 2230
Bettendorf, IA 52722
Phone (563) 742-5150

4480 Utica Ridge Rd
Ste 160
Bettendorf, IA 52722
Phone (563) 742-5950

600 N College Ave
Ste 120
Geneseo, IL 61254
Phone (309) 944-5342

Interoperability endpoints

  • Direct secure messaging: tnygren631315@direct.unitypoint.org

Organizations & group practices 3

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 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": "1631577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631577600000",
    "number": "1467122242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1105 HACKER ST",
            "city": "BUFFALO",
            "state": "IA",
            "postal_code": "527287776",
            "telephone_number": "308-233-2353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 HACKER ST",
            "city": "BUFFALO",
            "state": "IA",
            "postal_code": "527287776",
            "telephone_number": "308-233-2353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NYGREN",
        "first_name": "TREY",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-09-14",
        "last_updated": "2021-09-14",
        "certification_date": "2021-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085.008287",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IA",
            "license": "108364",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Buffalo, IA

Sources for this page

Verify at the official NPI Registry.