Tyson Agnew, PA
Individual provider Active NPI Physician Assistant · Fort Wayne, IN
NPI 1801614524 · NPPES record last updated Oct 1, 2024
Key facts
- NPI
- 1801614524
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- Practice address
- 5050 N Clinton St
Fort Wayne, IN 46825-5886 - Phone
- (260) 484-8551
- Fax
- (260) 482-5060
- NPI assigned
- Oct 1, 2024
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Orthopaedics Northeast PC
Practice addresses (Care Compare)
11136 Parkview Circle Dr
Fort Wayne, IN 46845-1730
Phone (260) 484-8551
5050 N Clinton St
Fort Wayne, IN 46825-5886
Phone (260) 484-8551
5052 N Clinton St
Fort Wayne, IN 46825-5822
8202 Glencarin Blvd
Suite 300
Fort Wayne, IN 46804-5783
Phone (260) 484-8551
885 W Connexion Way
Suite 200
Columbia City, IN 46725-1045
Phone (260) 248-9280
Hospital & facility affiliations
- Parkview Regional Medical Center
- Orthopaedic Hospital at Parkview North
- Parkview Whitley Hospital
- Parkview Huntington Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241205002260 | IN | Practitioner - Physician Assistant | 0143756718 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Orthopaedics Northeast PC | Current |
Accepting new patients | |
| Orthopaedics Northeast PC | Current |
Accepting new patients |
Locations
11136 Parkview Circle Dr
Fort Wayne, IN 46845
8202 Glencarin Blvd
Ste 300
Fort Wayne, IN 46804
Phone (260) 484-1855
5052 N Clinton St
Fort Wayne, IN 46825
Phone (260) 408-2203
5050 N Clinton St
Fort Wayne, IN 46825
Phone (219) 484-8551
315 E 200 N
Warsaw, IN 46582
Phone (574) 269-8301
1500 Provident Dr
Ste B
Warsaw, IN 46580
Phone (574) 269-8301
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Yes |
Addresses
Primary practice location
5050 N Clinton St
Fort Wayne, IN 46825-5886
Mailing address
5052 N Clinton St
Fort Wayne, IN 46825-5822
Phone (260) 484-8551
Other practice location 1
8202 Glencarin Blvd Ste 300
Fort Wayne, IN 46804-5783
Phone (260) 484-8551
Other practice location 2
1500 Provident Dr Ste B
Warsaw, IN 46580-3297
Phone (574) 269-8301
Other practice location 3
11136 Parkview Circle Dr
Fort Wayne, IN 46845-1730
Phone (260) 484-8551
Other providers in Fort Wayne, IN
- Sanjiv G Aggarwal
- Aging & in-Home Services of Northeast Indiana, Inc.
- Aging & in-Home Services of Northeast Indiana, Inc.
- Brookelyn Agler
- Krista Clarice Agler
- Dinesh Agnihotri
- Danielle Aguilar
- Mary Kathleen Aguilar
- Gabriel Aguilera
- Christianah Agunanne
All providers in Fort Wayne, IN · Physician Assistant in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 1, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.