Tyson Rand Kinnick, PBT(ASCP), PHD, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA.0008078 Issued in CO

Practice address

128 Market St
Alamosa, CO 81101-2290

Phone

(719) 587-1001

NPI assigned

Feb 26, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IA, IL, WY3 enrollments

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 3

Specialty

Physician Assistant

Education

Other, 2013

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Hospital & facility affiliations

• Arkansas Valley Regional Medical Center Hospital, Lajuna, CO, CCN 061336

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant, Doctor of Philosophy

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/0187d1c0-26b8-42cb-81e4-84d2429978e8/
• Direct secure messaging: summitprimarycare.tysonkinnick@157142.advancedmd-direct.com

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.

• Hancock County Health System

  • Critical Access Hospital
  • Britt, IA
  • NPI 1689721318
  Medicare reassignment NPD
• Pekin Prohealth Inc

  • Family Medicine Physician
  • Pekin, IL
  • NPI 1932150299
  Medicare reassignment NPD
• Community Health Center of Central Wyoming, Inc.

  • Federally Qualified Health Center (FQHC)
  • Casper, WY
  • NPI 1447480561
  Medicare reassignment
• Summit Primary Care

  • Family Medicine Physician
  • Englewood, CO
  • NPI 1356962849
  NPD
• Summit Primary Care

  • Community/Behavioral Health Agency
  • Colorado Springs, CO
  • NPI 1720861230
  NPD
• Hancock County Health System

  • Family Medicine Physician
  • Britt, IA
  • NPI 1144434283
  NPD
• Carle Health Care Incorporated

  • Internal Medicine Physician
  • Urbana, IL
  • NPI 1154653947
  NPD (past)

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

• Arkansas Valley Regional Medical Center

  • Critical Access Hospital
  • La Junta, CO
  • NPI 1760489470
  Care Compare affiliation

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

{
    "created_epoch": "1393372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705536000000",
    "number": "1881019925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5647 US HIGHWAY 26",
            "city": "DUBOIS",
            "state": "WY",
            "postal_code": "825139607",
            "telephone_number": "307-455-2516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "128 MARKET ST",
            "city": "ALAMOSA",
            "state": "CO",
            "postal_code": "811012290",
            "telephone_number": "719-587-1001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KINNICK",
        "first_name": "TYSON",
        "middle_name": "RAND",
        "name_prefix": "Dr.",
        "credential": "PBT(ASCP), PHD, PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-02-26",
        "last_updated": "2024-01-18",
        "certification_date": "2024-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IA",
            "license": "002413",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0008078",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WY LICENSE NUMBER",
            "identifier": "986",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI NUMBER",
            "identifier": "1881019925",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lottie Keith
• Anneliese B Keller, D.O.
• Robert R. Kelly, M.D.
• Stephanie Kelly
• Shayna Kindschuh
• Kendal Charles Knaus, MD
• Veronica Ann Knecht
• Bethany Lynn Kolb, M.D.
• Joshua Armstrong Koontz, PHARMD
• Julie E Kove, LP

• Physician Assistant in Alamosa, CO
• Providers in Alamosa, CO by specialty
• Physician Assistant in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2024; 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.