NPIMap

Individual provider Active NPI

Tyler John Halstead, PA-C

  • Physician Assistant
  • Nitro, WV
National Provider Identifier
1730725151
Registry record updated Mar 30, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
826 Issued in WV
Practice address
4111 1St Ave Ste 3
Nitro, WV 25143-1345
Phone
(304) 755-4797
Fax
(304) 755-4799
NPI assigned
Nov 20, 2019
Last updated
Mar 30, 2026By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 30, 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 826 WV Primary

Addresses

Primary practice location

4111 1St Ave Ste 3
Nitro, WV 25143-1345

Mailing address

4111 1St Ave Ste 3
Nitro, WV 25143-1345
Phone (304) 755-4797

Other identifiers 1

IdentifierTypeStateIssuer
1730725151MedicaidWV

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tyler.halstead@camc.cernerdirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201117001037 WV Practitioner - Physician Assistant 5991116378 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

2851 Charleston Rd
Suite 2
Poca, WV 25159-7652
Phone (304) 351-3015

314 Goff Mountain Rd
Suite 3
Cross Lanes, WV 25313-6600
Phone (304) 388-7070

400 Association Dr
Suite 102
Charleston, WV 25311-1298

4111 1St Ave
Suite 3
Nitro, WV 25143-1345
Phone (304) 755-4797

501 Morris St
Charleston, WV 25301-1326
Phone (304) 388-5432

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.94 of 100Reported as apm
Quality
69.71
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
826WVMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Charleston Area Medical Center Inc CurrentSince Oct 1, 2020 Accepting new patients
Charleston Area Medical Center, Inc. CurrentSince Oct 1, 2020 Accepting new patients
Charleston Area Medical Center Inc Past Accepting new patients

Locations

501 Morris St
Charleston, WV 25301
Phone (304) 348-6293

3703 Teays Valley Rd
Hurricane, WV 25526
Phone (304) 757-2273

4111 1st Ave
Ste 3
Nitro, WV 25143
Phone (304) 755-4797

Interoperability endpoints

  • Direct secure messaging: tyler.halstead@camc.cernerdirect.com

Organizations & group practices 4

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.

Hospital & facility affiliations 11

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": "1574208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774828800000",
    "number": "1730725151",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4111 1ST AVE STE 3",
            "city": "NITRO",
            "state": "WV",
            "postal_code": "251431345",
            "telephone_number": "304-755-4797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4111 1ST AVE STE 3",
            "city": "NITRO",
            "state": "WV",
            "postal_code": "251431345",
            "telephone_number": "304-755-4797",
            "fax_number": "304-755-4799"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALSTEAD",
        "first_name": "TYLER",
        "middle_name": "JOHN",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-11-20",
        "last_updated": "2026-03-30",
        "certification_date": "2026-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WV",
            "license": "826",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1730725151",
            "state": "WV"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tyler.halstead@camc.cernerdirect.com",
            "affiliation": "N",
            "address_1": "4111 1st Ave Ste 3",
            "city": "Nitro",
            "state": "WV",
            "country_code": "US",
            "postal_code": "251431345",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Nitro, WV

Sources for this page

Verify at the official NPI Registry.