Tyler Elizabeth Dick, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601009828 Issued in MI

Practice address

555 W 14 Mile Rd
Clawson, MI 48017-3100

Phone

(248) 655-1400

NPI assigned

Jul 7, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Miss Tyler Elizabeth Thal Former name

Medicare fee-for-service enrollment

Enrolled in IL

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: tyler.dick.1@28573.direct.athenahealth.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.

• North Woodward Internal Medicine Associates, P.C.

  • Internal Medicine Physician
  • Clawson, MI
  • NPI 1609966696
  NPD (past)

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

{
    "created_epoch": "1467849600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593993600000",
    "number": "1902258585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "995 LONGSPUR BLVD",
            "city": "LAKE ORION",
            "state": "MI",
            "postal_code": "483602560",
            "telephone_number": "248-860-8353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 W 14 MILE RD",
            "city": "CLAWSON",
            "state": "MI",
            "postal_code": "480173100",
            "telephone_number": "248-655-1400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICK",
        "first_name": "TYLER",
        "middle_name": "ELIZABETH",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-07-07",
        "last_updated": "2020-07-06",
        "certification_date": "2020-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601009828",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TYLER",
            "last_name": "THAL",
            "middle_name": "ELIZABETH",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• George Datsenko, RDN
• Davinnci Dental PLLC
• Jessica Nicole Davis, RDH
• Kirk F Diamond, RPH
• Molly Diana
• Patrick Dodd, PHARMD
• Jacqueline Kay Donnelly
• Meghann Donovan, FNP-BC
• Hina S Doshi, MD PC
• Dr Steven M Matlen PC

• Physician Assistant in Clawson, MI
• Providers in Clawson, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2020; 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.