TYLER RODERICKS (DPM) – Student in an Organized Health Care Education/Training Program, NPI 1760045447

TYLER RODERICKS (DPM) is a healthcare provider. based in San jose, California. specializing in PODIATRY. They hold the professional credentials DPM. They hold a License No. PDL1528 (MA). The NPI Number for TYLER RODERICKS (DPM) is 1760045447

Main info

Male
6 Years Of Experience
Accepts Medicare Assignment
Name
TYLER RODERICKS (DPM)
NPI
1760045447
Phone
(408) 693-1999
Address
1642 HUSTED AVE
Enumeration Date
17 April 2019
Last Update Date
3 June 2023

Doctor Profile

Medical School Name
WESTERN UN OF HLTH SCIENCES, COL OF PODIATRIC MED
Secondary Phone
3607611285
Graduation Year
2020 (6 years ago)
PAC ID
0941667646
Group Practice PAC ID
2163774076
Professional Enrollment ID
I20240709004570
Address ID
WA980222638EN1145XSTXX300
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience52
Completeness75
Years active:7State licenses:2Digital endpointsOther names

386 PODIATRY in MA

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Provider Addresses for TYLER RODERICKS (DPM)

  • 1642 HUSTED AVE

    SAN JOSE, CA 951255040

    Phone: (408) 693-1999

    Type: Mailing

  • Mount Auburn Hospital, 330, Mount Auburn Street, Coolidge Hill, Cambridge, Middlesex County, Massachusetts, 02138, United States

    CAMBRIDGE, MA 021385502

    Phone: (617) 492-3500

    Type: Location

  • 27 ASHLAND ST

    WATERTOWN, MA 024722920

    Phone: (408) 693-1999

    Type: Mailing

  • 12416 66TH ST STE A

    LARGO, FL 337733430

    Phone: (727) 547-4700

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 30 Open Payments records for all available years, with a total value of $2,696.

Total Amount is formed as General ($2,696) + Research ($0) + Ownership ($0) = $2,696.

Last reported payment date: 2024-11-12 • Largest payer in this snapshot: TriMed, Inc. ($1,340).

Total Amount

$2,696

General + Research + Ownership

Payments

30

Total payment records

General Amount

$2,696

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-11-12

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2024-07-09

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking 2 Medicare enrollment records; no due dates published yet.

Enrollment records

2

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20230612002991IPodiatryFLTBD
I20240709004570IPodiatryWATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 95125)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 2163774076View full group profile
NameSpecialtyState
P O D I A T R YKY
P O D I A T R YWA

Reviews

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Frequently asked questions

How do payers reference TYLER RODERICKS (DPM)?
For TYLER RODERICKS (DPM), use NPI 1760045447 as the unique 10-digit identifier.
Would TYLER RODERICKS (DPM) appear as active to a payer?
You can treat TYLER RODERICKS (DPM) as active for directory purposes; confirm clinical privileges separately.
What kind of doctor is TYLER RODERICKS (DPM)?
TYLER RODERICKS (DPM) is associated with Student in an Organized Health Care Education/Training Program in the directory — Clinical services aligned with this taxonomy classification.
What locale is associated with TYLER RODERICKS (DPM)?
Directory geography for TYLER RODERICKS (DPM) centers on San Jose, California.
When was this NPI issued?
Enumeration for TYLER RODERICKS (DPM) is noted as April 17, 2019 where the registry provides it.

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