TYLER ROTH LARSON (PA-C) – Physician Assistant, NPI 1003211103
Physician Assistant
Main info
Doctor Profile
Contacts
Profile Insights
NPPES metrics only — not quality of care.
2,499 PHYSICIAN ASSISTANT in IN
Provider Addresses for TYLER ROTH LARSON (PA-C)
855 WEBSTER ST UNIT 1204
FORT WAYNE, IN 468022258
Phone: (410) 693-9242
Type: Mailing
3640 NEW VISION DR
FORT WAYNE, IN 468451716
Phone: (260) 482-5091
Type: Location
PO BOX 1189
CORVALLIS, OR 973391189
Phone:
Type: Mailing
1289 49TH AVE
SWEET HOME, OR 97386
Phone: (541) 451-6250
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
Loading prescription activity...
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: 2020-10-13
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 |
|---|---|---|---|---|
| I20201013001368 | I | Physician Assistant | OR | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 46802)
Loading plans...
Group practice members
| Name | Specialty | State |
|---|---|---|
| Internal Medicine | CA | |
| Vascular Surgery | OR | |
| - | WA | |
| Internal Medicine | VT | |
| - | OR | |
| Physician Assistant | CA | |
| Infectious Disease, Internal Medicine | OR | |
| O B S T E T R I C S/ G Y N E C O L O G Y | OR | |
| Cardiovascular Disease (Cardiology) | FL | |
| Physician Assistant | OR |
Reviews
All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.
No reviews yet. Be the first to share your experience — your opinion helps families compare providers.