Individual provider Active NPI

Tyler Witmer, PA-C

  • Physician Assistant
  • Cedar Falls, IA
National Provider Identifier
1831460922
Registry record updated Jan 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA182471 Issued in OR
Practice address
2316 Valley Park Dr
Cedar Falls, IA 50613-4428
Phone
(319) 239-5832
NPI assigned
Jan 20, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 002262 IA
Physician Assistant 363A00000X PA182471 OR Primary

Addresses

Primary practice location

2316 Valley Park Dr
Cedar Falls, IA 50613-4428

Mailing address

109B E Ellendale Ave
Dallas, OR 97338-1794
Phone (503) 437-3594

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171228002541 OR Practitioner - Physician Assistant 1557520194 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emurgent Care LLCGroup PAC ID 9830325075, 2 clinicians

Practice addresses (Care Compare)

109 B E Ellendale Ave
Dallas, OR 97338-1794
Phone (503) 623-3199

Hospital & facility affiliations

  • Legacy Silverton Medical Center Hospital, Silverton, OR, CCN 380029

Merit-based Incentive Payment System (MIPS)

Final score
95.41 of 100Reported as group
Quality
88.83
Promoting interoperability
100
Improvement activities
40
Cost
82.4

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Northwest Acute Care Specialists PC CurrentSince Apr 20, 2024 Accepting new patients
Silverton Health CurrentSince Dec 6, 2023 Accepting new patients
Emurgent Care LLC PastSince Jan 12, 2020 Accepting new patients

Locations

24800 SE Stark St
Gresham, OR 97030
Phone (503) 413-8407

1015 NW 22nd Ave
Portland, OR 97210
Phone (503) 413-7582

2801 N Gantenbein Ave
Portland, OR 97227
Phone (503) 413-2200

1919 NW Lovejoy St
Portland, OR 97209
Phone (503) 415-5600

347 Fairview St
Silverton, OR 97381
Phone (503) 873-5667

342 Fairview St
Silverton, OR 97381
Phone (503) 525-7660

19300 SW 65th Ave
Tualatin, OR 97062
Phone (503) 692-1212

Organizations & group practices 7

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.

Hospital & facility affiliations 1

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": "1327017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704412800000",
    "number": "1831460922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109B E ELLENDALE AVE",
            "city": "DALLAS",
            "state": "OR",
            "postal_code": "973381794",
            "telephone_number": "503-437-3594",
            "fax_number": "503-623-3398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2316 VALLEY PARK DR",
            "city": "CEDAR FALLS",
            "state": "IA",
            "postal_code": "506134428",
            "telephone_number": "319-239-5832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WITMER",
        "first_name": "TYLER",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-01-20",
        "last_updated": "2024-01-05",
        "certification_date": "2024-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IA",
            "license": "002262",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA182471",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cedar Falls, IA

Sources for this page

Verify at the official NPI Registry.