Tyson Andelin

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA60875340 Issued in WA

Practice address

605 S Coolidge St
Moses Lake, WA 98837-1893

Phone

(509) 765-0674

Fax

(509) 764-0344

NPI assigned

Jul 20, 2018

Last updated

Jun 14, 2021By 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 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Moses Lake Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Moses Lake, WA
  • NPI 1699862813
  Medicare reassignment
• Northwest Emergency Physicians LLC

  dba Nep

  • Emergency Medicine Physician
  • Arlington, WA
  • NPI 1235172370
  Medicare reassignment
• Northwest Physician Associates PC

  • Physician Assistant
  • Arlington, WA
  • NPI 1275567919
  Medicare reassignment
• Moses Lake Community Health Center

  dba Quincy Student Health and Wellness Center

  • Student Health Clinic/Center
  • Quincy, WA
  • NPI 1730756644
  NPD

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

{
    "created_epoch": "1532044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623628800000",
    "number": "1508343732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 S COOLIDGE ST",
            "city": "MOSES LAKE",
            "state": "WA",
            "postal_code": "988371893",
            "telephone_number": "509-765-0674",
            "fax_number": "509-764-0344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 S COOLIDGE ST",
            "city": "MOSES LAKE",
            "state": "WA",
            "postal_code": "988371893",
            "telephone_number": "509-765-0674",
            "fax_number": "509-764-0344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDELIN",
        "first_name": "TYSON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-20",
        "last_updated": "2021-06-14",
        "certification_date": "2021-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PENDING",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA60875340",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emelda Alvarado
• Ruth Alvarado, MED
• Isidro G Alvarez Sr.
• Noemi Amezcua, CDP
• Arezou Amidi, DPM
• Ann M Andersen, ARNP
• Blake Albert Anderson, ARNP, FNP-C
• Nicole Marie Anderson, ARNP
• Sandy D Anderson, DH
• Christine Andrzejewski, PT

• Physician Assistant in Moses Lake, WA
• Providers in Moses Lake, WA by specialty
• Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.