Tyler Lane Vail, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA9107669 Issued in FL

Practice address

17779 SW 2ND St
Pembroke Pines, FL 33029-3924

Phone

(954) 322-1110

Fax

(954) 322-1099

NPI assigned

Nov 11, 2013

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

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.

• Infinite Wellness of the Carolinas

  • Internal Medicine Physician
  • Monroe, NC
  • NPI 1902150832
  NPD (past)

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

{
    "created_epoch": "1384128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1384128000000",
    "number": "1902235971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17779 SW 2ND ST",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330293924",
            "telephone_number": "954-322-1110",
            "fax_number": "954-322-1099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17779 SW 2ND ST",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330293924",
            "telephone_number": "954-322-1110",
            "fax_number": "954-322-1099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAIL",
        "first_name": "TYLER",
        "middle_name": "LANE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-11-11",
        "last_updated": "2013-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9107669",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "FL",
            "license": "PA9107669",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• V- Care Mobile Health LLC
• V.I.P. Foot & Ankle Center, LLC
• Vab Benefits LLC
• Maryanne Vaca, DO
• John Vadakkan, PT
• Kayla Vaillant
• Phalante Valcin, ARNP
• Rose Valcin, APRN
• Gabriela Valderrama Pye
• Maria Alexandra Valderrama

• Surgical Physician Assistant in Pembroke Pines, FL
• Providers in Pembroke Pines, FL by specialty
• Surgical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2013; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.