Tyler Jordan Mckinnon (NPI# 1790131480, PAC ID# 7416237359) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is PHYSICIAN ASSISTANT.
| Nation Provider ID (NPI) | 1790131480 |
| PAC ID by PECOS | 7416237359 |
| Professional Enrollment ID | I20161209001580 |
| Full Name | Tyler Jordan Mckinnon |
| Organization Legal Name | MOUNTAIN WEST DERM - BLACKHART PLLC |
| Address |
271 Duffers Ln Cascade ID 83611-5506 |
| Phone Number | 2089394599 |
| Gender | M |
| Graduation Year | 2016 |
| Primary Specialty | PHYSICIAN ASSISTANT |
| Group Practice PAC ID | 1153609813 |
| Number of Group Practice Members | 51 |
| Accepts Medicare Assignment | Y |
| Address | Phone | Organization |
|---|---|---|
| 7733 W Emerald St, Boise, ID 83704-9020 | 2089394599 | MOUNTAIN WEST DERM - BLACKHART PLLC |
| 271 Duffers Ln, Cascade, ID 83611-5506 | 2089394599 | MOUNTAIN WEST DERM - BLACKHART PLLC |
| Measure Identifier | Measure Title | Performance Rate | Reporting Mechanism |
|---|---|---|---|
| ACI_EC_TRANS_PPHI_1 | Security Risk Analysis | % | |
| MIPS_EC_224_overall | Melanoma: Overutilization of Imaging Studies in Melanoma | 100% | |
| MIPS_EC_402_overall | Tobacco Use and Help with Quitting Among Adolescents | 90% | |
| MIPS_EC_431_overall | Preventive Care and Screening: Unhealthy Alcohol Use: Screening & Brief Counseling | 97% |
| Organization Legal Name | MOUNTAIN WEST DERM - BLACKHART PLLC |
| Physicians | 51 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Alexandria Noel Staub | Physician Assistant | Mountain West Derm - Blackhart Pllc | 2747 Ne Conners Ave, Bend, OR 97701-8738 |
| Irene Helen Mannering | Dermatology | Mountain West Derm - Blackhart Pllc | 640 W Moana Ln, Reno, NV 89509-4903 |
| Michael John Housley | Physician Assistant | Mountain West Derm - Blackhart Pllc | 271 Duffers Ln, Cascade, ID 83611-5506 |
| Dan E Rowe | Dermatology | Mountain West Derm - Blackhart Pllc | 3950 Gs Richards Blvd, Carson City, NV 89703-8457 |
| Doug Starley | Physician Assistant | Mountain West Derm - Blackhart Pllc | 4814 Sparks Blvd, Sparks, NV 89436-8219 |
| James H Stewart | Dermatology | Mountain West Derm - Blackhart Pllc | 7733 W Emerald St, Boise, ID 83704-9020 |
| Anthony E Albregts | Dermatology | Mountain West Derm - Blackhart Pllc | 640 W Moana Ln, Reno, NV 89509-4903 |
| Stephanie A Mcleish | Dermatology | Mountain West Derm - Blackhart Pllc | 3841 Piper St, Suite T4 020, Anchorage, AK 99508-4673 |
| Kimberly A Kolar | Dermatology | Mountain West Derm - Blackhart Pllc | 640 W Moana Ln, Reno, NV 89509-4903 |
| Amy Richelle Schoening | Physician Assistant | Mountain West Derm - Blackhart Pllc | 640 W Moana Ln, Reno, NV 89509-4903 |
| Street Address |
271 DUFFERS LN |
| City | CASCADE |
| State | ID |
| Zip | 83611-5506 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Michael John Housley | Physician Assistant | Mountain West Derm - Blackhart Pllc | 271 Duffers Ln, Cascade, ID 83611-5506 |
| Chelsea Faust | Physician Assistant | Mountain West Derm - Blackhart Pllc | 271 Duffers Ln, Cascade, ID 83611-5506 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Jennifer S Anderson | Cardiovascular Disease (cardiology) | Saint Alphonsus Regional Medical Center Inc | 402 Lake Cascade Pkwy, Cascade, ID 83611-7702 |
| Marc T Nagel | Physician Assistant | Cascade Medical Center Hospital District | 402 Lake Cascade Pkwy, Cascade, ID 83611-7702 |
| James W Dardis | Family Medicine | Cascade Medical Center Hospital District | 402 Lake Cascade Pkwy, Cascade, ID 83611-7702 |
| Ronald K Ellsworth | Family Medicine | Cascade Medical Center Hospital District | 402 Lake Cascade Pkwy, Cascade, ID 83611-7702 |
| Chantell Williams | Nurse Practitioner | Cascade Medical Center Hospital District | 402 Lake Cascade Pkwy, Cascade, ID 83611-7702 |
| Jamie Coffey Kelly | Clinical Social Worker | Cascade Medical Center Hospital District | 402 Lake Cascade Pkwy, Cascade, ID 83611-7702 |
| City | CASCADE |
| Zip Code | 83611 |
| Specialty | PHYSICIAN ASSISTANT |
| City + Specialty | CASCADE + PHYSICIAN ASSISTANT |
Please comment or provide details below to improve the information on Tyler Jordan Mckinnon.
| 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.