Justin James Tynan, PA-C, MPH

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

PA59854 Issued in CA

Practice address

3280 Professional Dr
Auburn, CA 95602-2412

Phone

(530) 886-8630

NPI assigned

Mar 31, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

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, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Sansum ClinicGroup PAC ID 3678471976, 320 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Goleta Valley Cottage Hospital Hospital, Santa Barbara, CA, CCN 050357

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jtynan563155@hisp.ehr.sutterhealth.org

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.

• Sansum Clinic

  • Multi-Specialty Clinic/Center
  • Santa Barbara, CA
  • NPI 1154354504
  Medicare reassignment Care Compare group
• Sansum Clinic

  • Ambulatory Surgical Clinic/Center
  • Santa Barbara, CA
  • NPI 1144648015
  NPD
• Sansum Clinic

  • Ambulatory Surgical Clinic/Center
  • Santa Barbara, CA
  • NPI 1649296807
  NPD (past)

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

• Goleta Valley Cottage Hospital

  • General Acute Care Hospital
  • Santa Barbara, CA
  • NPI 1225038136
  Care Compare affiliation

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

{
    "created_epoch": "1585612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643155200000",
    "number": "1619505922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3280 PROFESSIONAL DR",
            "city": "AUBURN",
            "state": "CA",
            "postal_code": "956022412",
            "telephone_number": "916-626-2902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3280 PROFESSIONAL DR",
            "city": "AUBURN",
            "state": "CA",
            "postal_code": "956022412",
            "telephone_number": "530-886-8630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TYNAN",
        "first_name": "JUSTIN",
        "middle_name": "JAMES",
        "credential": "PA-C, MPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-03-31",
        "last_updated": "2022-01-26",
        "certification_date": "2021-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "PA59854",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "GMail",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "student related activites",
            "address_1": "1310 Club Dr",
            "city": "Vallejo",
            "state": "CA",
            "country_code": "US",
            "postal_code": "945921187",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Wendy Marie Turner, BA
• Turning Point Community Programs
• Russell L Tweet, M.D.
• Kim Twilling
• Michael Tyler, M.D.
• Brook Malan Udall, DDS
• Chika Queen Ugwu, PMHNP
• Ulmus Holdings, LLC
• Beau Ulrich, D.D.S.
• Bruce Michael Ulrich, DDS

• Family Medicine Physician in Auburn, CA
• Providers in Auburn, CA by specialty
• Family Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2022; 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.