Individual provider Active NPI

Tyson Carlson, MD

  • Family Medicine Physician
  • Lincoln, NE
National Provider Identifier
1609446566
Registry record updated Jul 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
TEP9191 Issued in NE
Practice address
4600 Valley Rd Ste 200
Lincoln, NE 68510-4882
Phone
(402) 483-4571
Fax
(402) 483-5079
NPI assigned
Jul 1, 2021
Last updated
Jul 1, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X TEP9191 NE Primary

Addresses

Primary practice location

4600 Valley Rd Ste 200
Lincoln, NE 68510-4882

Mailing address

4600 Valley Rd
Lincoln, NE 68510-4855
Phone (402) 483-4591

Other identifiers 1

IdentifierTypeStateIssuer
470553011-00MedicaidNE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tyson.carlson.1@9271.direct.athenahealth.com Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241114001174 NE Practitioner - Family Practice 6305234824 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Nebraska College of Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fallbrook Family Health CenterGroup PAC ID 2365612785, 4 clinicians

Practice addresses (Care Compare)

755 Fallbrook Blvd
Suite 100
Lincoln, NE 68521-4643
Phone (402) 441-3575

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
TEP9191NEMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Superior Street Family Physicians Current Accepting new patients
Fallbrook Family Health Center Family Medicine CurrentSince Aug 30, 2024 Accepting new patients

Locations

755 Fallbrook Blvd
Ste 100
Lincoln, NE 68521
Phone (402) 441-3575

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": "1625097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625097600000",
    "number": "1609446566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4600 VALLEY RD",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685104855",
            "telephone_number": "402-483-4591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4600 VALLEY RD STE 200",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685104882",
            "telephone_number": "402-483-4571",
            "fax_number": "402-483-5079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "TYSON",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-01",
        "last_updated": "2021-07-01",
        "certification_date": "2021-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NE",
            "license": "TEP9191",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "470553011-00",
            "state": "NE"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tyson.carlson.1@9271.direct.athenahealth.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "4600 Valley Rd Ste 200",
            "city": "Lincoln",
            "state": "NE",
            "country_code": "US",
            "postal_code": "685104882",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lincoln, NE

Sources for this page

Verify at the official NPI Registry.