TYLER CLARK (MD) – Family Medicine Physician, NPI 1124414305
Family Medicine Physician
Main info
Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
969 FAMILY PRACTICE in ID
Provider Addresses for TYLER CLARK (MD)
307 ST JOHNS WAY STE 11
LEWISTON, ID 83501
Phone:
Type: Mailing
307 SAINT JOHNS WAY STE 11
LEWISTON, ID 835012435
Phone: (208) 750-3832
Fax: (208) 750-3830
Type: Location
2003 KOOTENAI HEALTH WAY
COEUR D ALENE, ID 838146051
Phone: (208) 625-4955
Fax: (208) 625-4956
Type: Mailing
1701 LINCOLN WAY
COEUR D ALENE, ID 838142537
Phone: (208) 625-4955
Fax: (208) 625-4956
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 7 Open Payments records for all available years, with a total value of $125.
Total Amount is formed as General ($125) + Research ($0) + Ownership ($0) = $125.
Last reported payment date: 2024-08-22 • Largest payer in this snapshot: PFIZER INC. ($35).
Total Amount
$125
General + Research + Ownership
Payments
7
Total payment records
General Amount
$125
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-08-22
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| PFIZER INC. | $35 |
| Exact Sciences Corporation | $24 |
| Otsuka America Pharmaceutical, Inc. | $20 |
| Abbott Laboratories | $18 |
| ABBVIE INC. | $14 |
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: 2018-11-02
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
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20181102001987 | I | Family Practice | ID | TBD |
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.
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.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 324 | 181 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 296 | 160 | $0 |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 145 | 145 | $0 |
| 99203 | New patient office or other outpatient visit, 30-44 minutes | 48 | 48 | $0 |
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 35 | 35 | $0 |
Insurance plans in this area (ZIP 83501)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Orthopedic Surgery | ID | |
| Physician Assistant | ID | |
| Surgical Oncology, Hematology/Oncology, General Surgery | WA | |
| Pulmonary Disease, Critical Care (Intensivists) | ID | |
| Physician Assistant | ID | |
| Undefined Non Physician Type (Specify) | ID | |
| Physician Assistant | UT | |
| Certified Nurse Midwife (Cnm) | ID | |
| Physician Assistant | ID | |
| Internal Medicine | TX |
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