Individual provider Active NPI

Tyler Martin

  • Physician Assistant
  • Charleston, SC
National Provider Identifier
1649524455
Registry record updated Mar 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1868 Issued in SC
Practice address
2095 Henry Tecklenburg Dr
Charleston, SC 29414-5733
Phone
(843) 402-1037
Fax
(843) 402-1295
NPI assigned
Oct 31, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1868 SC Primary

Addresses

Primary practice location

2095 Henry Tecklenburg Dr
Charleston, SC 29414-5733

Mailing address

PO Box 602645
Charlotte, NC 28260-2645
Phone (843) 789-1620

Other practice location 1

8740 Rivers Ave
North Charleston, SC 29406-9211
Phone (843) 572-5990

Other identifiers 1

IdentifierTypeStateIssuer
1901PAMedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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

Enrollment IDStateProvider typePAC IDDetails
I20141028001495 SC Practitioner - Physician Assistant 5890916241 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Charleston Carenow Urgent Care LLCGroup PAC ID 3274893359, 72 clinicians

Practice addresses (Care Compare)

1115 Savannah Hwy
Charleston, SC 29407-7805
Phone (843) 300-3355

1675 N Main St
Summerville, SC 29486-7847
Phone (843) 285-2169

1850 Sam Rittenberg Blvd
Charleston, SC 29407-4936
Phone (843) 793-6093

2863 N Hwy 17
Mt Pleasant, SC 29466-8962
Phone (843) 606-3911

8720 Dorchester Rd
North Charleston, SC 29420-7303
Phone (843) 552-3629

8740 Rivers Ave
North Charleston, SC 29406-9211
Phone (843) 377-2406

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science, Physician Assistant

State licenses

LicenseStateTypeSpecialty
1868SCMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Roper St. Francis Mount Pleasant Hospital CurrentSince Sep 1, 2020 Accepting new patients
Roper Hospital Inc CurrentSince Sep 1, 2020 Accepting new patients
Roper St. Francis Mount Pleasant Hospital CurrentSince Sep 1, 2020 Accepting new patients
Medcare Express - North Charleston LLC CurrentSince Dec 11, 2018 Accepting new patients
Bon Secours St Francis Xavier Hospital, Inc. CurrentSince May 5, 2014 Accepting new patients
Bon Secours St. Francis Xavier Hospital, Inc. CurrentSince May 5, 2014 Accepting new patients
Roper Hospital Inc. CurrentSince Sep 1, 2020 Accepting new patients
Charleston Carenow Urgent Care, LLC PastSince May 16, 2026 Accepting new patients

Locations

316 Calhoun St
Charleston, SC 29401
Phone (843) 724-2000

2095 Henry Tecklenburg Dr
Charleston, SC 29414
Phone (843) 402-1037

1115 Savannah Hwy
Charleston, SC 29407
Phone (843) 300-3355

1850 Sam Rittenberg Blvd
Ste B
Charleston, SC 29407
Phone (843) 576-5246

7418 Garners Ferry Rd
Columbia, SC 29209
Phone (803) 509-6310

10136 Two Notch Rd
Ste 104
Columbia, SC 29229
Phone (803) 509-7570

2863 N Highway 17
Mt Pleasant, SC 29466
Phone (843) 469-6803

3500 N Highway 17
Mt Pleasant, SC 29466
Phone (843) 606-7000

8720 Dorchester Rd
Ste 1201
North Charleston, SC 29420
Phone (843) 552-3629

8740 Rivers Ave
North Charleston, SC 29406
Phone (843) 337-2406

8720 Dorchester Rd
North Charleston, SC 29420
Phone (843) 552-3629

3816 Highway 17 S
North Myrtle Beach, SC 29582
Phone (843) 272-1411

201 Business Center Dr
Pawleys Island, SC 29585
Phone (843) 314-3209

301 E Wood St
Spartanburg, SC 29303
Phone (843) 576-5246

1675 N Main St
Summerville, SC 29486
Phone (843) 285-2169

110 Medical Cir
Ste A
West Columbia, SC 29169

Organizations & group practices 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1351641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774742400000",
    "number": "1649524455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 602645",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282602645",
            "telephone_number": "843-789-1620",
            "fax_number": "843-724-2454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2095 HENRY TECKLENBURG DR",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294145733",
            "telephone_number": "843-402-1037",
            "fax_number": "843-402-1295"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8740 Rivers Ave",
            "address_purpose": "LOCATION",
            "city": "North Charleston",
            "state": "SC",
            "postal_code": "294069211",
            "country_code": "US",
            "telephone_number": "843-572-5990",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "TYLER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-10-31",
        "last_updated": "2026-03-29",
        "certification_date": "2026-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "1868",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1901PA",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

Verify at the official NPI Registry.