NPIMap

Individual provider Active NPI

Tyler W Wark, MD

  • Cardiovascular Disease Physician
  • Middlebury, VT
National Provider Identifier
1871085134
Registry record updated Aug 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
042.0017863 Issued in VT
Practice address
115 Porter Dr
Middlebury, VT 05753-8629
Phone
(802) 388-4701
NPI assigned
Jun 3, 2018
Last updated
Aug 28, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 28, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X LP04290 RI
Cardiovascular Disease Physician 207RC0000X 1871085134 VT
Cardiovascular Disease Physician 207RC0000X 042.0017863 VT Primary

Addresses

Primary practice location

115 Porter Dr
Middlebury, VT 05753-8629

Mailing address

111 Colchester Ave
Burlington, VT 05401-1473
Phone (802) 847-4600

Other practice location 1

111 Colchester Ave
Burlington, VT 05401-1473
Phone (802) 847-4600

Other practice location 2

593 Eddy St
Providence, RI 02903-4923
Phone (401) 793-2930

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT, NY2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20241004001760 VT Practitioner - Internal MedicinePractitioner - Cardiovascular Disease (Cardiology) 3173927183 Reassigns benefits to 3 organizations
I20241120000734 NY Practitioner - Cardiovascular Disease (Cardiology) 3173927183 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Cardiovascular Disease (Cardiology)
Education
University of Vermont College of Medicine, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Porter Hospital IncGroup PAC ID 1850365180, shared by 5 NPIs, 116 clinicians
Elizabethtown Community HospitalGroup PAC ID 3577554138, shared by 3 NPIs, 62 clinicians

Practice addresses (Care Compare)

111 Colchester Ave
Burlington, VT 05401-1473
Phone (802) 847-0000

115 Porter Dr
Middlebury, VT 05753-8423
Phone (802) 382-3443

75 Park St
Elizabethtown, NY 12932-2300
Phone (518) 673-6377

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
330344NYMDLicensed Practical Nurse
LP04290RIMDInternal Medicine Physician
042.0017863VTMDCardiovascular Disease Physician
1871085134VTMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Elizabethtown Community Hospital CurrentSince Oct 13, 2024 Accepting new patients
Porter Hospital, Inc Internal Medicine CurrentSince Aug 4, 2024 Accepting new patients
University of Vermont Medical Center Inc Internal Medicine CurrentSince Oct 14, 2024 Accepting new patients
Porter Hospital Inc Current Accepting new patients
Elizabethtown Community Hospital Current Accepting new patients
University of Vermont Medical Center Inc Past Accepting new patients
Porter Hospital Inc PastSince Oct 26, 2009 Accepting new patients

Locations

61 Court Dr
Brandon, VT 05733
Phone (802) 247-3755

1 S Prospect St
Burlington, VT 05401
Phone (802) 847-4531

111 Colchester Ave
Burlington, VT 05401
Phone (802) 656-2415

104 Porter Dr
Middlebury, VT 05753
Phone (802) 388-5682

115 Porter Dr
Middlebury, VT 05753
Phone (802) 388-4701

82 Catamount Park
Middlebury, VT 05753
Phone (802) 388-7185

Interoperability endpoints

  • FHIR API: https://fhir-usa.unify.chbase.com/org/elizabe-e663f886

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 22

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1527984000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724803200000",
    "number": "1871085134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 COLCHESTER AVE",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "054011473",
            "telephone_number": "802-847-4600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 PORTER DR",
            "city": "MIDDLEBURY",
            "state": "VT",
            "postal_code": "057538629",
            "telephone_number": "802-388-4701"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "111 Colchester Ave",
            "address_purpose": "LOCATION",
            "city": "Burlington",
            "state": "VT",
            "postal_code": "054011473",
            "country_code": "US",
            "telephone_number": "802-847-4600",
            "fax_number": "802-847-2533",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "593 Eddy St",
            "address_purpose": "LOCATION",
            "city": "Providence",
            "state": "RI",
            "postal_code": "029034923",
            "country_code": "US",
            "telephone_number": "401-793-2930",
            "fax_number": "401-793-2953",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WARK",
        "first_name": "TYLER",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-06-03",
        "last_updated": "2024-08-28",
        "certification_date": "2024-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "RI",
            "license": "LP04290",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "VT",
            "license": "1871085134",
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "VT",
            "license": "042.0017863",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Middlebury, VT

Sources for this page

Verify at the official NPI Registry.