TYLER SCOTT MITTELSTAEDT (MD-MPH) – Surgery Physician, NPI 1053678284
Surgery Physician
Main info
Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
530 GENERAL SURGERY in OR
Provider Addresses for TYLER SCOTT MITTELSTAEDT (MD-MPH)
PO BOX 3158
PORTLAND, OR 972083158
Phone: (503) 215-6494
Type: Mailing
9200 SE 91ST AVE STE 320
PORTLAND, OR 970863756
Phone: (503) 353-3005
Fax: (503) 546-3201
Type: Mailing
9200 SE 91st Ave Ste 320
Portland, OR 970863756
Phone: (503) 353-3005
Fax: (503) 546-3201
Type: Location
1510 DIVISION ST STE 210
OREGON CITY, OR 970451599
Phone: (503) 723-6525
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $19.
Total Amount is formed as General ($19) + Research ($0) + Ownership ($0) = $19.
Last reported payment date: 2024-10-24 • Largest payer in this snapshot: Alnylam Pharmaceuticals Inc. ($19).
Total Amount
$19
General + Research + Ownership
Payments
1
Total payment records
General Amount
$19
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-10-24
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Alnylam Pharmaceuticals Inc. | $19 |
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: 2022-01-25
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
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20170926004089 | I | General Surgery | OR | TBD |
| I20220125001738 | I | General Surgery | WA | 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 97208)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Family Practice | WA | |
| - | OR | |
| - | MT | |
| Emergency Medicine | WA | |
| Cardiovascular Disease (Cardiology) | WA | |
| Family Practice | OR | |
| Emergency Medicine | CA | |
| - | MI | |
| Family Practice | OR | |
| Family Practice | NC |
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