Individual provider Active NPI

Tyler D Ingersoll, DO

  • Family Medicine Physician
  • Justin, TX
National Provider Identifier
1952939183
Registry record updated Jul 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
U8743 Issued in TX
Practice address
1976 Texan Dr Ste 106
Justin, TX 76247-6774
Phone
(682) 212-9020
NPI assigned
Apr 1, 2020
Last updated
Jul 17, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X OK
Family Medicine Physician 207Q00000X U8743 TX Primary
Sports Medicine (Family Medicine) Physician 207QS0010X U8743 TX

Addresses

Primary practice location

1976 Texan Dr Ste 106
Justin, TX 76247-6774

Mailing address

2345 Southwest Blvd
Tulsa, OK 74107-2705
Phone (918) 349-1500

Other practice location 1

2345 Southwest Blvd
Tulsa, OK 74107-2705
Phone (918) 582-1980

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240712002081 TX Practitioner - Family PracticePractitioner - Sports Medicine 8527433713 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Sports Medicine
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Texas Health Physicians GroupGroup PAC ID 4385535954, 1,364 clinicians

Practice addresses (Care Compare)

1976 Texan Dr
Suite 106
Justin, TX 76247-6774
Phone (682) 212-9020

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
7476OKMDDentist
U8743TXMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Health Physicians Group Family Medicine CurrentSince Aug 1, 2024 Accepting new patients
Texas Health Physicians Group Current Accepting new patients
Texas Health Physicians Group CurrentSince Aug 1, 2024 Accepting new patients
Texas Health Physicians Group Family Medicine Past Accepting new patients

Locations

1600 Hospital Pkwy
Bedford, TX 76022
Phone (817) 355-7803

4333 N Josey Ln
Ste 104
Carrollton, TX 75010
Phone (972) 394-4500

1976 Texan Dr
Ste 106
Justin, TX 76247
Phone (682) 212-9020

Interoperability endpoints

  • Direct secure messaging: tingersoll2542630@direct.texashealth.org

Organizations & group practices 4

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 1

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

NPI Registry JSON

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

{
    "created_epoch": "1585699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752710400000",
    "number": "1952939183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2345 SOUTHWEST BLVD",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741072705",
            "telephone_number": "918-349-1500",
            "fax_number": "918-439-1199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1976 TEXAN DR STE 106",
            "city": "JUSTIN",
            "state": "TX",
            "postal_code": "762476774",
            "telephone_number": "682-212-9020"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2345 Southwest Blvd",
            "address_purpose": "LOCATION",
            "city": "Tulsa",
            "state": "OK",
            "postal_code": "741072705",
            "country_code": "US",
            "telephone_number": "918-582-1980",
            "fax_number": "918-561-1289",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "INGERSOLL",
        "first_name": "TYLER",
        "middle_name": "D",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-01",
        "last_updated": "2025-07-17",
        "certification_date": "2025-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OK",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "U8743",
            "primary": true
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "TX",
            "license": "U8743",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Justin, TX

Sources for this page

Verify at the official NPI Registry.