Tyler S Mittelstaedt (NPI# 1053678284, PAC ID# 4486809076) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is GENERAL SURGERY.
| Nation Provider ID (NPI) | 1053678284 |
| PAC ID by PECOS | 4486809076 |
| Professional Enrollment ID | I20170926004089 |
| Full Name | Tyler S Mittelstaedt |
| Organization Legal Name | PORTLAND SURGICAL SPECIALISTS PC |
| Address |
9200 Se 91st Ave Suite 320 Portland OR 97086-3756 |
| Phone Number | 5033533005 |
| Gender | M |
| Medical School | OREGON HEALTH SCIENCES UNIVERSITY SCHOOL OF MEDICINE |
| Graduation Year | 2012 |
| Primary Specialty | GENERAL SURGERY |
| Group Practice PAC ID | 8628099983 |
| Number of Group Practice Members | 3 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 380082 | PROVIDENCE MILWAUKIE HOSPITAL |
| 380061 | PROVIDENCE PORTLAND MEDICAL CENTER |
| Address | Phone | Organization |
|---|---|---|
| 9200 Se 91st Ave, Suite 320, Portland, OR 97086-3756 | 5033533005 | PORTLAND SURGICAL SPECIALISTS PC |
| Organization Legal Name | PORTLAND SURGICAL SPECIALISTS PC |
| Physicians | 3 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| John S Domreis | General Surgery | Portland Surgical Specialists PC | 9200 Se 91st Ave, Suite 320, Portland, OR 97086-3756 |
| Thomas R Eubanks | General Surgery | Portland Surgical Specialists PC | 9200 Se 91st Ave, Suite 320, Portland, OR 97086-3756 |
| Street Address |
9200 SE 91ST AVE SUITE 320 |
| City | PORTLAND |
| State | OR |
| Zip | 97086-3756 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Danilyn R Allen | Nurse Practitioner | Joseph P. Stapleton, Md PC | 9200 Se 91st Ave, Suite 100, Portland, OR 97266-6756 |
| Alan Craig Thom | Family Medicine | Portland Adventist Medical Center | 9200 Se 91st Ave, Suite 220, Happy Valley, OR 97086-3756 |
| Druanne M Laplante | Family Medicine | Portland Adventist Medical Center | 9200 Se 91st Ave, Suite 220, Happy Valley, OR 97086-3756 |
| Rui Yang | Family Medicine | Portland Adventist Medical Center | 9200 Se 91st Ave, Suite 220, Happy Valley, OR 97086-3756 |
| John S Domreis | General Surgery | Portland Surgical Specialists PC | 9200 Se 91st Ave, Suite 320, Portland, OR 97086-3756 |
| Mai P Leopold | Family Medicine | Portland Adventist Medical Center | 9200 Se 91st Ave, Suite 220, Happy Valley, OR 97086-3756 |
| Jordi X Kellogg | Neurosurgery | Jordi X Kellogg Md PC | 9200 Se 91st Ave, Suite 340, Portland, OR 97086-3756 |
| Stan Sizheng Lei | Anesthesiology | Oregon Anesthesiology Group PC | 9200 Se 91st Ave, Suite 100, Portland, OR 97086-3756 |
| Thomas R Eubanks | General Surgery | Portland Surgical Specialists PC | 9200 Se 91st Ave, Suite 320, Portland, OR 97086-3756 |
| Omar J Gonzalez | Physician Assistant | Jordi X Kellogg Md PC | 9200 Se 91st Ave, Suite 340, Portland, OR 97086-3756 |
| Find all physicians in the same address | |||
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Hoang Q Nguyen | Internal Medicine | Columbia Medical Clinic PC | 9995 Se 82nd Ave, Happy Valley, OR 97086-2301 |
| Jeffrey C Dart | Family Medicine | Northwest Primary Care Group PC | 12119 Se Stevens Ct, Happy Valley, OR 97086-2620 |
| Karen Kuo | Physical Therapy | Northwest Primary Care Group PC | 12119 Se Stevens Ct, Happy Valley, OR 97086-2620 |
| Sharon E Mcneill | Family Medicine | Northwest Primary Care Group PC | 12119 Se Stevens Ct, Happy Valley, OR 97086-2620 |
| David Vitello | Nurse Practitioner | Northwest Primary Care Group PC | 12119 Se Stevens Ct, Happy Valley, OR 97086-2620 |
| Kristin Sentman Bendert | Family Medicine | Northwest Primary Care Group PC | 12119 Se Stevens Ct, Happy Valley, OR 97086-2620 |
| Eric D Brown | Physical Therapy | Northwest Primary Care Group PC | 12119 Se Stevens Ct, Happy Valley, OR 97086-2620 |
| Melissa Thompson | Physician Assistant | Northwest Primary Care Group PC | 12119 Se Stevens Ct, Happy Valley, OR 97086-2620 |
| Cathy Stores | Physical Therapy | Northwest Primary Care Group PC | 12119 Se Stevens Ct, Happy Valley, OR 97086-2620 |
| Kristen G Shaffer | Nurse Practitioner | Legacy Clinics LLC | 9361 Se 82nd Ave, Happy Valley, OR 97086-3645 |
| Find all physicians in zip 97086 | |||
| City | PORTLAND |
| Zip Code | 97086 |
| Specialty | GENERAL SURGERY |
| City + Specialty | PORTLAND + GENERAL SURGERY |
Please comment or provide details below to improve the information on Tyler S Mittelstaedt.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.