Active NPI
Tyler Madison Gaines, MD
- Urology Physician
- Philadelphia, PA
National Provider Identifier
1861017402
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- License
- HS000003L
- Practice address
- 1200 W Tabor Rd
Philadelphia, PA 19141-3019 - Phone
- (215) 456-4600
- Fax
- (215) 456-9334
- NPI assigned
- Jun 9, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician | 208800000X | HS000003L | PA | Primary |
Addresses
Primary practice location
1200 W Tabor Rd
Philadelphia, PA 19141-3019
Mailing address
1200 W Tabor Rd
Philadelphia, PA 19141-3019
Phone (215) 456-4600
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| HS000003L | PA | MD | Orthopaedic Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1591660800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1591660800000",
"number": "1861017402",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1200 W TABOR RD",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191413019",
"telephone_number": "215-456-4600",
"fax_number": "215-456-9334"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 W TABOR RD",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191413019",
"telephone_number": "215-456-4600",
"fax_number": "215-456-9334"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAINES",
"first_name": "TYLER",
"middle_name": "MADISON",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-06-09",
"last_updated": "2020-06-09",
"certification_date": "2020-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "PA",
"license": "HS000003L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.