Tyler Stephen Clutter, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

10003930A Issued in IN

Practice address

5215 Holy Cross Pkwy
Mishawaka, IN 46545-1469

Phone

(574) 523-3160

Fax

(574) 523-3221

NPI assigned

Dec 19, 2022

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

Medicare fee-for-service enrollment

Enrolled in IN

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

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tclutter2117146@direct.trinity-health.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.

• Cep America LLC

  • Emergency Medicine Physician
  • Terre Haute, IN
  • NPI 1285103671

  IN

  Medicare reassignment
• Elite Emergency Physicians Inc

  • Emergency Medicine Physician
  • Elkhart, IN
  • NPI 1932155371

  IN

  Medicare reassignment
• Cep America LLC

  • Emergency Medicine Physician
  • Indianapolis, IN
  • NPI 1548912553
  NPD
• Cep America LLC

  • Emergency Medicine Physician
  • Fort Lauderdale, FL
  • NPI 1700747946
  NPD

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

{
    "created_epoch": "1671408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744070400000",
    "number": "1679285993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5215 HOLY CROSS PKWY",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465451469",
            "telephone_number": "574-523-3160",
            "fax_number": "574-523-3221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5215 HOLY CROSS PKWY",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465451469",
            "telephone_number": "574-523-3160",
            "fax_number": "574-523-3221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLUTTER",
        "first_name": "TYLER",
        "middle_name": "STEPHEN",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-12-19",
        "last_updated": "2025-04-08",
        "certification_date": "2025-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IN",
            "license": "10003930A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angel May Clements
• Grant Patrick Cleveland, DDS
• Stacey J Closson, LMHC
• Kimberly Anne Cloud, COTA
• Connie Clougher, RN
• Alyssa Cockey
• Katie Cole, MD
• Michal Cole
• Meghan Collins
• Michele Nicole Collins, M.D.

• All providers in Mishawaka, IN
• Medical Physician Assistant in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2025; 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.