Tyler Adam Pezalski, M.D.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

MD457219 Issued in PA

Practice address

1800 E Park Ave
State College, PA 16803-6709

Phone

(814) 231-7100

NPI assigned

Jun 24, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in PA

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

Anesthesiology

Education

Pennsylvania State University College of Medicine, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mount Nittany Medical CenterGroup PAC ID 2365353364, 45 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mount Nittany Medical Center Hospital, State College, PA, CCN 390268

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Mount Nittany Medical Center

  • Anesthesiology Physician
  • State College, PA
  • NPI 1528321015
  Medicare reassignment Care Compare group NPD
• Mount Nittany Medical Center

  • Clinic/Center
  • State College, PA
  • NPI 1194521302
  NPD
• Oban Anesthesia Consultants, PLLC

  • Anesthesiology Physician
  • Laurinburg, NC
  • NPI 1821035775
  NPD (past)

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

• Mount Nittany Medical Center

  • Pain Clinic/Center
  • State College, PA
  • NPI 1104991801

  Hospital

  Care Compare affiliation
• Mount Nittany Medical Center

  • Clinic/Center
  • State College, PA
  • NPI 1194521302

  Hospital

  Care Compare affiliation
• Mount Nittany Medical Center

  • General Acute Care Hospital
  • State College, PA
  • NPI 1730173154
  Care Compare affiliation
• Mount Nittany Medical Center

  • Ambulatory Surgical Clinic/Center
  • State College, PA
  • NPI 1780750620

  Hospital

  Care Compare affiliation
• Mount Nittany Medical Center

  • Ambulatory Surgical Clinic/Center
  • State College, PA
  • NPI 1780752378

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1214265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1473811200000",
    "number": "1760643472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 16",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168040016",
            "telephone_number": "814-466-5090",
            "fax_number": "814-466-5095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 E PARK AVE",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168036709",
            "telephone_number": "814-231-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEZALSKI",
        "first_name": "TYLER",
        "middle_name": "ADAM",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-06-24",
        "last_updated": "2016-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NC",
            "license": "2012-02188",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "VA",
            "license": "0101246832",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "PA",
            "license": "MD457219",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1031202100001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Joseph Petkus, PA-C
• Angela J Petrick, PT
• John Nason Pettengill, MSPT, CERT MDT
• Kathy Pettet
• Maria T. Pettinger, M.D.
• Matthew Phillips
• Stephen Harry Phillips II, D.O.
• Tyler Robert Phillips, DC
• Phoenix Rehabilitation and Health Services, Inc.
• Phoenix Rehabilitation and Health Services, Inc.

• Anesthesiology Physician in State College, PA
• Providers in State College, PA by specialty
• Anesthesiology Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2016; 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.