Tyler J Rundell, PA-C
Individual provider Active NPI Physician Assistant · Green River, UT
NPI 1861962912 · NPPES record last updated Dec 3, 2018
Key facts
- NPI
- 1861962912
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 10877596-8906 (UT)
- Practice address
- 585 Main St
Green River, UT 84525 - Phone
- (435) 564-3434
- NPI assigned
- Dec 3, 2018
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 19
Hospital & facility affiliations 12
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Duke University Affiliated Physicians, Inc.
Carolina Physical Therapy Associates LLC
Legacy Healthcare Services Inc
Practice addresses (Care Compare)
11635 Northpark Dr
Wake Forest, NC 27587-6526
Phone (919) 570-6060
1501 N Bickett Blvd
Louisburg, NC 27549-2178
Phone (919) 497-8414
1901 Hillandale Rd
Durham, NC 27705-2664
205 Sandalwood Ave
Louisburg, NC 27549-2679
Phone (919) 684-8111
234 Crooked Creek Pkwy
Suite 200
Durham, NC 27713-8506
Phone (919) 213-6631
2701 Pickett Rd
Durham, NC 27705-5688
Phone (919) 419-9600
Hospital & facility affiliations
- Amedisys Home Health
- Centerwell Home Health
- Wakemed Home Health
- Duke Home Health
- Duke University Hospital
- Maria Parham Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in UT, NC
- 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 |
|---|---|---|---|---|
| I20190304002854 | UT | Practitioner - Physician Assistant | 5698014983 | Reassigns benefits to 1 organization |
| I20240731000922 | NC | Practitioner - Physician Assistant | 5698014983 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10877596-8906 | UT | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Duke University Affiliated Physicians, Inc. | Current |
Accepting new patients | |
| Duke University Affiliated Physicians, Inc. | Current |
Accepting new patients | |
| Duke University Affiliated Physicians, Inc. | Current | Accepting new patients |
Locations
5716 Fayetteville Rd
Durham, NC 27713
Phone (919) 572-1862
1901 Hillandale Rd
Ste D
Durham, NC 27705
Phone (919) 383-4355
401 Irving Pkwy
Holly Springs, NC 27540
Phone (919) 385-3800
10211 Alm St
Raleigh, NC 27617
Phone (919) 206-4868
7021 Harps Mill Rd
Raleigh, NC 27615
Phone (919) 823-5446
3000 Rogers Rd
Wake Forest, NC 27587
Phone (919) 385-1080
Interoperability endpoints
- trundell586867@direct.medicine.duke.edu
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 10877596-8906 | UT | Yes |
Addresses
Primary practice location
585 Main St
Green River, UT 84525
Mailing address
4325 S Doreen Cir
Millcreek, UT 84107-2816
Phone (607) 316-3109
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10877596-1206 | Other | UT | UTAH DIVISION OF OCCUPATIONAL AND PROFESSIONAL LICENSING |
| 10877596-8906 | Other | UT | UTAH DIVISION OF OCCUPATIONAL AND PROFESSIONAL LICENSING |
| 1152696 | Other | NATIONAL COMMISSION ON CERTIFICATION OF PHYSICIAN ASSISTANTS |
Other providers in Green River, UT
- Green River Medical Center Inc
- Green River Medical Center Inc
- Green River Medical Center, Inc.
- Brouquelyn Mia Hatfield-Knight
- Kim Thyrill McFarlane
- Zackery N Taylor
- Shannon Taylor Thurston
- Dallin Trout
- Loye West
- Reagan M Whiteleather
All providers in Green River, UT · Physician Assistant in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 3, 2018. 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.