TYLER JAY STALEY (M.D.) – Sports Medicine (Physical Medicine & Rehabilitation) Physician, NPI 1013189877

TYLER JAY STALEY (M.D.) is a healthcare provider. based in Daytona beach, Florida. specializing in SPORTS MEDICINE. They hold the professional credentials M.D.. They hold a License No. 44335 (KY). The NPI Number for TYLER JAY STALEY (M.D.) is 1013189877

Main info

Male
19 Years Of Experience
Accepts Medicare Assignment
Name
TYLER JAY STALEY (M.D.)
NPI
1013189877
Phone
(386) 676-7130
Address
PO BOX 9671
Enumeration Date
1 April 2008
Last Update Date
11 July 2013

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3862383200
Graduation Year
2007 (19 years ago)
PAC ID
0446403299
Group Practice PAC ID
9436201233
Professional Enrollment ID
I20130104000156
Address ID
FL321142733DA350XXBLVD500
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience64
Completeness75
Years active:18State licenses:2Digital endpointsOther names

419 SPORTS MEDICINE in FL

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Provider Addresses for TYLER JAY STALEY (M.D.)

  • PO BOX 9671

    DAYTONA BEACH, FL 321209671

    Phone: (386) 676-7130

    Fax: (386) 676-7125

    Type: Mailing

  • 350, North Clyde Morris Boulevard, Daytona Beach, Volusia County, Florida, 32114, United States

    DAYTONA BEACH, FL 321142733

    Phone: (386) 238-3290

    Fax: (386) 238-3278

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

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: 2013-01-04

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

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
I20130104000156ISports MedicineFLTBD

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 32120)

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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: 9436201233View full group profile

Reviews

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Frequently asked questions

What federal number belongs to TYLER JAY STALEY (M.D.)?
The federal identifier for TYLER JAY STALEY (M.D.) is NPI 1013189877.
Is TYLER JAY STALEY (M.D.) active in the national directory?
TYLER JAY STALEY (M.D.)'s public NPI profile is in an active state.
Can you summarize TYLER JAY STALEY (M.D.)'s specialty in plain language?
Clinically, the directory lists TYLER JAY STALEY (M.D.) with Sports Medicine (Physical Medicine & Rehabilitation) Physician. Clinical services aligned with this taxonomy classification.
What location shows for TYLER JAY STALEY (M.D.)?
We surface Daytona Beach, Florida for TYLER JAY STALEY (M.D.) based on available NPPES addresses.
Is TYLER JAY STALEY (M.D.) a real provider?
This page reflects official NPPES data for NPI 1013189877. Always confirm identity and privileges with the practice and licensing boards.

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