Tye Frank Johnson, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

10701069-1206 Issued in UT

Practice address

555 W Sr 164
Salem, UT 84653

Phone

(801) 465-4896

Fax

(801) 465-3267

NPI assigned

Mar 15, 2018

Last updated

Nov 27, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in UT

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

Specialty

Physician Assistant

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ihc Health Services IncGroup PAC ID 1850209420, 3,948 clinicians

Revere Health PCGroup PAC ID 7517868508, 407 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Intermountain Health Spanish Fork Hospital Hospital, Spanish Fork, UT, CCN 460062

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tyejohnson@cuccu.allscriptsdirect.net

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.

• Revere Health PC

  dba Revere Health

  • Multi-Specialty Clinic/Center
  • Provo, UT
  • NPI 1093764805
  Medicare reassignment Care Compare group NPD
• Ihc Health Services Inc

  • Multi-Specialty Clinic/Center
  • Sandy, UT
  • NPI 1942325154
  Medicare reassignment Care Compare group
• Ihc Health Services Inc

  dba Diabetic Care Center

  • Endocrinology, Diabetes & Metabolism Physician
  • Murray, UT
  • NPI 1699800375
  NPD
• Ihc Health Services, Inc.

  dba St George Adolescent Partial Hospitalization

  • Psychiatry Physician
  • St George, UT
  • NPI 1023843844
  NPD
• Revere Health PC

  dba Revere Health

  • Multi-Specialty Clinic/Center
  • Spanish Fork, UT
  • NPI 1851142285
  NPD
• Ihc Health Services Inc

  dba Orem Community Hospital Physicians

  • Multi-Specialty Clinic/Center
  • Orem, UT
  • NPI 1588601124
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Ihc Health Services, Inc.

  dba Intermountain Health Spanish Fork Hospital

  • General Acute Care Hospital
  • Spanish Fork, UT
  • NPI 1124661384
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1521072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1467955526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 N 500 W",
            "address_2": "ATTN: CREDENTIALING",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043305",
            "telephone_number": "801-354-8225",
            "fax_number": "801-418-0941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 W SR 164",
            "city": "SALEM",
            "state": "UT",
            "postal_code": "84653",
            "telephone_number": "801-465-4896",
            "fax_number": "801-465-3267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "TYE",
        "middle_name": "FRANK",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-03-15",
        "last_updated": "2023-11-27",
        "certification_date": "2020-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "10701069-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "medreview@reverehealth.com",
            "affiliation": "Y",
            "affiliationName": "Revere Health PC",
            "address_1": "555 W SR 164",
            "city": "Salem",
            "state": "UT",
            "country_code": "US",
            "postal_code": "84653",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Hulse Dentisry LLC (Salem Smiles Family Dentisry)
• Alma Iyon Soud, MD
• Colton Jackson, NP
• Addysun Jasperson
• McCall Jewett, NP
• Kashley Nicole Jones, FNP-C
• Kids Who Count
• Kids Who Count
• Adam Nelson Lee, B.S., D.D.S., M.S.
• Life Tree PLLC (Life Tree Psychiatry)

• Physician Assistant in Salem, UT
• Providers in Salem, UT by specialty
• Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.