NPIMap

Individual provider Active NPI

Tyler Shawn Passmore, PA-C

  • Physician Assistant
  • Du Bois, PA
National Provider Identifier
1730868019
Registry record updated Apr 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
OA006515 Issued in PA
Practice address
145 Hospital Ave Ste 212
Du Bois, PA 15801-1461
Phone
(814) 375-4045
Fax
(814) 375-4041
NPI assigned
Jul 14, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MA064608 PA
Physician Assistant 363A00000X OA006515 PA Primary

Addresses

Primary practice location

145 Hospital Ave Ste 212
Du Bois, PA 15801-1461

Mailing address

145 Hospital Ave
Du Bois, PA 15801-1462
Phone (814) 375-4045

Other practice location 1

100 Peach St Ste 400
Erie, PA 16507-1423
Phone (814) 877-9100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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
I20230822000792 PA Practitioner - Physician Assistant 8224490370 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dubois Regional Medical CenterGroup PAC ID 5890689715, shared by 39 NPIs, 424 clinicians
Keystone Rehabilitation Systems IncGroup PAC ID 7012826753, shared by 15 NPIs, 750 clinicians

Practice addresses (Care Compare)

100 Hospital Ave
Du Bois, PA 15801-1440
Phone (814) 375-3034

205 Hampton Ave
Punxsutawney, PA 15767-2133
Phone (814) 938-0148

Hospital & facility affiliations

  • Penn Highlands Dubois Hospital, Dubois, PA, CCN 390086
  • Penn Highlands Brookville Hospital, Brookville, PA, CCN 391312

Merit-based Incentive Payment System (MIPS)

Final score
81.89 of 100Reported as group
Quality
65.8
Promoting interoperability
100
Improvement activities
40
Cost
73.83

Merit-based Incentive Payment System (MIPS)

Final score
96.6 of 100Reported as group
Promoting interoperability
96
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MA064608PAMDPhysician Assistant
OA006515PAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Dubois Regional Medical Center CurrentSince May 1, 2024 Accepting new patients
Orthopaedic & Sports Medicine of Erie, PC CurrentSince Jul 1, 2023 Accepting new patients
Dubois Regional Medical Center CurrentSince May 1, 2024 Accepting new patients
Dubois Regional Medical Center CurrentSince May 1, 2024 Accepting new patients
Dubois Regional Medical Center Physician Assistant Past Accepting new patients

Locations

815 Doctors Dr
Clearfield, PA 16830
Phone (814) 205-1252

100 Hospital Ave
Dubois, PA 15801
Phone (814) 375-2040

145 Hospital Ave
Ste 212
Dubois, PA 15801
Phone (814) 375-6450

100 Peach St
Ste 400
Erie, PA 16507
Phone (814) 454-8287

761 Johnsonburg Rd
Ste 310
Saint Marys, PA 15857
Phone (814) 788-8577

Interoperability endpoints

  • Direct secure messaging: tspassmorre@1285.direct.myezyaccess.com

Organizations & group practices 6

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 32

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

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1689292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712793600000",
    "number": "1730868019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 HOSPITAL AVE",
            "city": "DU BOIS",
            "state": "PA",
            "postal_code": "158011462",
            "telephone_number": "814-375-4045",
            "fax_number": "814-375-4041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 HOSPITAL AVE STE 212",
            "city": "DU BOIS",
            "state": "PA",
            "postal_code": "158011461",
            "telephone_number": "814-375-4045",
            "fax_number": "814-375-4041"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Peach St Ste 400",
            "address_purpose": "LOCATION",
            "city": "Erie",
            "state": "PA",
            "postal_code": "165071423",
            "country_code": "US",
            "telephone_number": "814-877-9100",
            "fax_number": "814-454-8470",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PASSMORE",
        "first_name": "TYLER",
        "middle_name": "SHAWN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-07-14",
        "last_updated": "2024-04-11",
        "certification_date": "2024-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA064608",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "OA006515",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Du Bois, PA

Sources for this page

Verify at the official NPI Registry.