Individual provider Active NPI

Tyler David Matheson, CRNA

  • Certified Registered Nurse Anesthetist
  • Du Bois, PA
National Provider Identifier
1720857402
Registry record updated Dec 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
RN730303 Issued in PA
Practice address
100 Hospital Ave
Du Bois, PA 15801-1440
Phone
(814) 371-2200
NPI assigned
Dec 22, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X RN730303 PA Primary

Addresses

Primary practice location

100 Hospital Ave
Du Bois, PA 15801-1440

Mailing address

411 E Church St
Ligonier, PA 15658-1413
Phone (208) 908-2380

Other practice location 1

225 S Center Ave
Somerset, PA 15501-2033
Phone (814) 443-5000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240930000086 ID Practitioner - Certified Registered Nurse Anesthetist (Crna) 8628415460 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anesthesia Consulting Partners Idaho PCGroup PAC ID 5092164806, 8 clinicians
West Valley Medical Associates IncGroup PAC ID 9931467289, 28 clinicians

Practice addresses (Care Compare)

1717 Arlington Ave
Caldwell, ID 83605-4802
Phone (208) 459-4641

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RN730303PAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
West Valley Medical Associates Inc CurrentSince Jan 1, 2026 Accepting new patients
Anesthesia Consulting Partners Idaho, PC Nurse Anesthetist, Certified Registered CurrentSince Aug 1, 2024 Accepting new patients

Locations

1717 Arlington Ave
Caldwell, ID 83605
Phone (208) 455-3719

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 and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1703203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703203200000",
    "number": "1720857402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 E CHURCH ST",
            "city": "LIGONIER",
            "state": "PA",
            "postal_code": "156581413",
            "telephone_number": "208-908-2380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 HOSPITAL AVE",
            "city": "DU BOIS",
            "state": "PA",
            "postal_code": "158011440",
            "telephone_number": "814-371-2200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "225 S Center Ave",
            "address_purpose": "LOCATION",
            "city": "Somerset",
            "state": "PA",
            "postal_code": "155012033",
            "country_code": "US",
            "telephone_number": "814-443-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MATHESON",
        "first_name": "TYLER",
        "middle_name": "DAVID",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-12-22",
        "last_updated": "2023-12-22",
        "certification_date": "2023-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "PA",
            "license": "RN730303",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Du Bois, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.