Individual provider Active NPI

Tyler Egbert

  • Emergency Medicine Physician
  • Chicago, IL
National Provider Identifier
1801389853
Registry record updated Nov 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
036160308 Issued in IL
Practice address
635 N Dearborn St Ste 100
Chicago, IL 60654-4618
Phone
(312) 694-2127
Fax
(312) 694-2129
NPI assigned
Jun 13, 2018
Last updated
Nov 5, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 036160308 IL Primary
Emergency Medicine Physician 207P00000X 2018018672 MO

Addresses

Primary practice location

635 N Dearborn St Ste 100
Chicago, IL 60654-4618

Mailing address

One Hospital Drive
Suite M562
Columbia, MO 65212
Phone (573) 884-3233

Other practice location 1

One Hospital Drive
Suite M562
Columbia, MO 65212
Phone (573) 884-3233

Other practice location 2

200 E Fairman Ave
Watseka, IL 60970-1644
Phone (815) 432-7762

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tyler.egbert.1@15486.direct.athenahealth.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, IL, WI3 enrollments
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 3

Enrollment IDStateProvider typePAC IDDetails
I20210811004149 MO Practitioner - Emergency Medicine 5193071215 Reassigns benefits to 2 organizations
I20221221002402 IL Practitioner - Emergency Medicine 5193071215 Reassigns benefits to 4 organizations
I20231006000328 WI Practitioner - Emergency Medicine 5193071215 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Kansas School of Med (KC/Wich/Sal), 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Health System CorporationGroup PAC ID 7416860440, 749 clinicians
Statera Health Care LLCGroup PAC ID 0244565729, 41 clinicians

Practice addresses (Care Compare)

1000 Mineral Point Ave
Janesville, WI 53548-2940
Phone (608) 756-6000

1701 Lacey St
Cape Girardeau, MO 63701-5230
Phone (573) 334-4822

200 E Fairman Ave
Watseka, IL 60970-1644
Phone (815) 432-5841

635 N Dearborn St
Chicago, IL 60654-4618
Phone (312) 926-0404

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Statera Health Care, LLC Emergency Medicine CurrentSince Oct 1, 2024 Accepting new patients
Mercy Health System Corporation Current Accepting new patients
Morrison Community Hospital District Current Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Nov 1, 2022 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Nov 1, 2022 Accepting new patients
Southeastern Emergency Physicians of Memphis LLC Emergency Medicine CurrentSince Jul 1, 2021 Accepting new patients
Southeast Missouri Hospital Physicians, LLC CurrentSince Sep 7, 2022 Accepting new patients
Mercy Health System Corporation CurrentSince Sep 12, 2023 Accepting new patients
Iroquois Memorial Hospital and Resident Home Current Accepting new patients
Mercy Health System Corporation CurrentSince Sep 12, 2023 Accepting new patients
Central Dupage Physician Group Past Accepting new patients
Rockford Health Physicians Past Accepting new patients
Iroquois Memorial Hospital and Resident Home Past Accepting new patients
CGH Medical Center Past Accepting new patients

Locations

2250 N Illinois Ave
Carbondale, IL 62901
Phone (618) 833-1691

Dept 5777
Carol Stream, IL 60122

29624 Network Pl
Chicago, IL 60673
Phone (608) 741-7652

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

611 S Marshall Ave
Mc Leansboro, IL 62859
Phone (618) 542-2146

515 Valley View Dr
Ste 201
Moline, IL 61265
Phone (312) 695-0870

303 N Jackson St
Morrison, IL 61270
Phone (815) 772-4003

200 E Fairman Ave
Watseka, IL 60970
Phone (815) 432-5201

1600 E Broadway
Columbia, MO 65201
Phone (573) 632-5000

1701 Lacey St
Cpe Girardeau, MO 63701
Phone (573) 334-4822

1000 Mineral Point Ave
Janesville, WI 53548
Phone (608) 261-6868

3400 Deerfield Dr
Janesville, WI 53546
Phone (608) 314-3600

Interoperability endpoints

  • Direct secure messaging: tyler.egbert.1@15486.direct.athenahealth.com

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 4

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": "1528848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730764800000",
    "number": "1801389853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ONE HOSPITAL DRIVE",
            "address_2": "SUITE M562",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "65212",
            "telephone_number": "573-884-3233",
            "fax_number": "573-884-5994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "635 N DEARBORN ST STE 100",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606544618",
            "telephone_number": "312-694-2127",
            "fax_number": "312-694-2129"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "One Hospital Drive",
            "address_2": "Suite M562",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "MO",
            "postal_code": "65212",
            "country_code": "US",
            "telephone_number": "573-884-3233",
            "fax_number": "573-884-5994",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "200 E Fairman Ave",
            "address_purpose": "LOCATION",
            "city": "Watseka",
            "state": "IL",
            "postal_code": "609701644",
            "country_code": "US",
            "telephone_number": "815-432-7762",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EGBERT",
        "first_name": "TYLER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-13",
        "last_updated": "2024-11-05",
        "certification_date": "2024-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IL",
            "license": "036160308",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MO",
            "license": "2018018672",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tyler.egbert.1@15486.direct.athenahealth.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "200 E Fairman Ave",
            "city": "Watseka",
            "state": "IL",
            "country_code": "US",
            "postal_code": "609701644",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.