Tyler Dwane Mansberger, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

MA056247 Issued in PA

Practice address

6678 Towne Center Blvd
Huntingdon, PA 16652-6934

Phone

(814) 506-8490

Fax

(814) 506-8493

NPI assigned

Oct 22, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 12

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: t.mansberger@broadtopmedical.medentdirect.com

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.

• Broad Top Area Medical Center Inc

  dba BTAMC Walk In Clinic

  • Federally Qualified Health Center (FQHC)
  • Huntingdon, PA
  • NPI 1649769589
  NPD (past)

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

{
    "created_epoch": "1382400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661904000000",
    "number": "1811325228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4133 MEDICAL CENTER DR",
            "city": "BROAD TOP",
            "state": "PA",
            "postal_code": "166219001",
            "telephone_number": "814-635-2916",
            "fax_number": "814-635-2918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6678 TOWNE CENTER BLVD",
            "city": "HUNTINGDON",
            "state": "PA",
            "postal_code": "166526934",
            "telephone_number": "814-506-8490",
            "fax_number": "814-506-8493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANSBERGER",
        "first_name": "TYLER",
        "middle_name": "DWANE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-10-22",
        "last_updated": "2022-08-31",
        "certification_date": "2022-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "PA",
            "license": "MA056247",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0008434780002",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "400472",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102926115-0003",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102926115-0006",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102926115-0007",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102926115-0008",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102926115-0002",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PART-B PTAN",
            "identifier": "754008",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102926115-0005",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102926115-0004",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102926115-0009",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH CARITAS",
            "identifier": "709708",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mainstreamcounseling
• David Ryan Maletta, COTA/L
• Kevin Malicky, CRNP F-NP
• Louann Ruth Mansberger-Darby, M.S., L.P.C., L.P.N.
• James Warren Mansberger, DO
• Kaitlyn Marhefka
• Sarah Elizabeth Martz, DPT
• Julie M. Mazer, P.T.
• Katie Lauren McAleer, PMHNP
• John Bradley McCarty, DPT

• Physician Assistant in Huntingdon, PA
• Providers in Huntingdon, PA by specialty
• Physician Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.