Tyler Fanning, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

MD216942 Issued in OR

Practice address

1112 NW Circle Blvd
Corvallis, OR 97330-1462

Phone

(541) 768-5235

NPI assigned

Mar 26, 2018

Last updated

Sep 19, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OR

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Good Samaritan Hospital Corvallis

  dba Good Samaritan Regional Medical Center

  • General Acute Care Hospital
  • Corvallis, OR
  • NPI 1962453134
  Medicare reassignment NPD
• Corvallis Psychiatry LLC

  • Psychiatry Physician
  • Portland, OR
  • NPI 1023995768
  NPD Authorized official
• Good Samaritan Hospital Corvallis

  dba Samaritan Gynecologic Oncology - Corvallis

  • Gynecologic Oncology Physician
  • Corvallis, OR
  • NPI 1710787916
  NPD
• Good Samaritan Hospital Corvallis

  dba Samaritan Cardiology-Corvallis

  • Cardiovascular Disease Physician
  • Corvallis, OR
  • NPI 1841554151
  NPD

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

{
    "created_epoch": "1522022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695081600000",
    "number": "1760987473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1189",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973391189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1112 NW CIRCLE BLVD",
            "city": "CORVALLIS",
            "state": "OR",
            "postal_code": "973301462",
            "telephone_number": "541-768-5235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANNING",
        "first_name": "TYLER",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-03-26",
        "last_updated": "2023-09-19",
        "certification_date": "2023-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OR",
            "license": "MD216942",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "VT",
            "license": "042.0014873",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tfanning263037@samhealth.direct-ci.com",
            "affiliation": "N",
            "address_1": "1112 NW Circle Blvd",
            "city": "Corvallis",
            "state": "OR",
            "country_code": "US",
            "postal_code": "973301462",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Family Recovery Non-Profit, Inc. (Milestones Womens Program)
• Family Recovery Non-Profit, Inc. (YES House)
• Family Recovery, Inc. (Milestones Family Recovery)
• Family Recovery, Inc. (Recovery Wellness Center)
• Christopher J Fang, MD
• Stephanie Christina Farenik
• Cyrus Hakhamanish Faridi, DO
• Samantha Farmer
• Craig Farrell
• Sterling Farrer, DO

• Psychiatry Physician in Corvallis, OR
• Providers in Corvallis, OR by specialty
• Psychiatry Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.