Tyler Randall Davis, MD
Individual provider Active NPI Emergency Medicine Physician · Monroe, LA
NPI 1972064160 · NPPES record last updated May 16, 2023
Key facts
- NPI
- 1972064160
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- 329162 (LA)
- Practice address
- 4864 Jackson St
Monroe, LA 71202-6400 - Phone
- (318) 330-7000
- NPI assigned
- Mar 29, 2019
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 6
Hospital & facility affiliations 6
Medicare Care Compare profile
- Specialty
- Emergency Medicine
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Cross Lake Emergency Group, LLC
Hospital Service District No. 1 of Caldwell Parish
Practice addresses (Care Compare)
2400 Hospital Dr
Bossier City, LA 71111-2385
Phone (318) 212-7000
7939 Hwy 165
Columbia, LA 71418-3327
Phone (318) 649-6106
PO Box
Suite 1079
Columbia, LA 71418-1079
PO Box
Suite 1079
Columbia, LA 71418-3327
Hospital & facility affiliations
- Willis Knighton Medical Center
- Citizens Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220131000627 | LA | Practitioner - Emergency Medicine | 3779811658 | Reassigns benefits to 4 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 329162 | LA | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cross Lake Emergency Group, LLC | Emergency Medicine | Current |
Accepting new patients |
| Hospital Service District No. 1 of Caldwell Parish | Emergency Medicine | Current |
Accepting new patients |
| Lsu Health Sciences Center Shreveport Faculty Group Practice | Emergency Medicine | Current |
Accepting new patients |
| Hospital Service District No. 1 Caldwell Parish | Current |
Accepting new patients | |
| Highland Emergency Group, LLC | Emergency Medicine | Current |
Accepting new patients |
Locations
2531 Viking Dr
Bossier City, LA 71111
Phone (318) 681-7000
4864 Jackson St
Monroe, LA 71202
Phone (318) 330-7000
1501 Kings Hwy
Shreveport, LA 71103
Phone (318) 626-0434
8001 Youree Dr
Shreveport, LA 71115
Phone (318) 212-3000
1606 Kings Hwy
Shreveport, LA 71103
Phone (318) 675-6402
1453 E Bert Kouns Industrial Loop
#L
Shreveport, LA 71105
1453 E Bert Kouns Industrial Loop
Shreveport, LA 71105
Phone (318) 681-4138
1512 W Kirby Pl
Shreveport, LA 71103
Phone (318) 626-0177
2600 Greenwood Rd
Shreveport, LA 71103
Phone (318) 212-4600
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 329162 | LA | Yes |
Addresses
Primary practice location
4864 Jackson St
Monroe, LA 71202-6400
Mailing address
1512 W Kirby PL
Shreveport, LA 71103-3822
Phone (318) 626-0287
Other providers in Monroe, LA
- Sharon Davis
- Shetoquie Davis
- Steven Jacob Davis
- Stevens Davis Jr.
- Tia Davis
- Willie Davis
- Woodrow Davis
- Liz Sophia Dawkins
- Dalal Dawud
- Melissa Anne De la O
All providers in Monroe, LA · Emergency Medicine Physician in Louisiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 16, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.