Tyler Graham Kimbrough, MD

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

MD60667019 Issued in WA

Practice address

21616 76TH Ave W
Suite 112
Edmonds, WA 98026-7512

Phone

(425) 775-6651

NPI assigned

Feb 14, 2007

Last updated

Jul 14, 2011By 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 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Otolaryngology

Education

University of Washington School of Medicine, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Proliance Surgeons Inc P SGroup PAC ID 8527972900, 395 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Swedish Edmonds Hospital Hospital, Edmonds, WA, CCN 500026
• Swedish Medical Center Hospital, Seattle, WA, CCN 500027

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tyler.kimbrough.p46@direct.proliance.nextgenshare.com

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.

• Proliance Surgeons Inc P S

  dba Proliance Surgeons Orthopedic Specialists of Seattle

  • Orthopaedic Surgery Physician
  • Seattle, WA
  • NPI 1023170313
  Medicare reassignment Care Compare group NPD
• Proliance Surgeons Inc P S

  dba Proliance Orthopedic Associates

  • Orthopaedic Surgery Physician
  • Renton, WA
  • NPI 1235091463
  NPD
• Proliance Surgeons, Inc., P.S.

  dba Proliance Surgeons Puget Sound ENT

  • Otolaryngology Physician
  • Edmonds, WA
  • NPI 1770764342
  NPD
• Proliance Surgeons Inc., P.S.

  dba Orthopedic Physician Associates

  • Orthopaedic Surgery Physician
  • Seattle, WA
  • NPI 1558300434
  NPD (past)

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

• Swedish Edmonds

  • General Acute Care Hospital
  • Edmonds, WA
  • NPI 1033107214
  Care Compare affiliation
• Swedish Edmonds

  • Clinical Medical Laboratory
  • Edmonds, WA
  • NPI 1699894022

  Hospital

  Care Compare affiliation
• Swedish Health Services

  • General Acute Care Hospital
  • Seattle, WA
  • NPI 1306992151
  Care Compare affiliation

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

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1310601600000",
    "number": "1720121361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 MADISON ST",
            "address_2": "SUITE 901",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981041172",
            "telephone_number": "206-264-8100",
            "fax_number": "206-264-8689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21616 76TH AVE W",
            "address_2": "SUITE 112",
            "city": "EDMONDS",
            "state": "WA",
            "postal_code": "980267512",
            "telephone_number": "425-775-6651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIMBROUGH",
        "first_name": "TYLER",
        "middle_name": "GRAHAM",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-14",
        "last_updated": "2011-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "WA",
            "license": "MD60667019",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jake T Kim, LICSW
• Jeung Kim
• John Kim
• Kris Kim, D.D.S., M.S.D.
• Brooke Annette Kimball, LMP
• Amber L King, LMP
• Jessica J King, PA C
• Kimberly Lynn King, N.D., LAC
• Lauren Juanita King, D.C., F.A.C.O.
• Lauri Lynn King, PT

• Otolaryngology Physician in Edmonds, WA
• Providers in Edmonds, WA by specialty
• Otolaryngology Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2011; 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.