Ty Nielson

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

4425 E Agave Rd Ste 148
Phoenix, AZ 85044-0623

Phone

(480) 704-7546

NPI assigned

Apr 6, 2015

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

Medicare fee-for-service enrollment

Enrolled in AZ

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

Specialty

Physician Assistant

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Desert Sky Dermatology PLLCGroup PAC ID 3971753054, 13 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

92.32 of 100Reported as group

Quality

99.63

Improvement activities

40

Cost

74.89

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Desert Sky Dermatology, PLLC

  • Dermatology Physician
  • Gilbert, AZ
  • NPI 1871851691
  Medicare reassignment Care Compare group
• Southwest Skin Laboratory PLLC

  • Clinical Medical Laboratory
  • Gilbert, AZ
  • NPI 1124386966
  NPD (past)

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

{
    "created_epoch": "1428278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1503273600000",
    "number": "1871988980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4425 E AGAVE RD STE 148",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850440623"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4425 E AGAVE RD STE 148",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850440623",
            "telephone_number": "480-704-7546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NIELSON",
        "first_name": "TY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-04-06",
        "last_updated": "2017-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicole Nielsen, MA
• Tricia M Nielsen, CRNA
• Jason Curtis Nielson, DC
• Marcus Nielson, PMHNP-BC
• Paul Michael Nielson, DDS
• Theresa R Nieman, M.D.
• Nicki Niemann, M.D.
• Alex W Niemczura, OT
• Jennifer Niemeyer, PA-C
• Heather Rae Niemyer

• Medical Physician Assistant in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Medical Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.