Justin Tyler Tidwell, DNP, NP in Stanford, CA

Justin Tyler Tidwell, DNP, NP is a medicare enrolled "Nurse Practitioner" in Stanford, California. His current practice location is 300 Pasteur Dr, Stanford, California. You can reach out to his office (for appointments etc.) via phone at (650) 723-4000.

Justin Tyler Tidwell is licensed to practice in California (license number 95000691) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1245648922.

Contact Information

	Justin Tyler Tidwell, DNP, NP
	300 Pasteur Dr, Stanford, CA 94305-2200
	(650) 723-4000
	Not Available

Map and Direction

Provider's Profile

Full Name	Justin Tyler Tidwell
Gender	Male
Speciality	Nurse Practitioner
Location	300 Pasteur Dr, Stanford, California
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1245648922
Provider Enumeration Date: 07/26/2014
Last Update Date: 11/06/2024

Medicare PECOS Information:

PECOS PAC ID: 6608140843
Enrollment ID: I20170926004088

Medical Identifiers

Medical identifiers for Justin Tyler Tidwell such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1245648922	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363LA2100X	Nurse Practitioner - Acute Care	95000691 (California)	Secondary
363L00000X	Nurse Practitioner	95000691 (California)	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Justin Tyler Tidwell allows following entities to bill medicare on his behalf.

Entity Name	Permanente Medical Group Inc
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1073606299 PECOS PAC ID: 8921910225 Enrollment ID: O20031104000710

Entity Name	Stanford Health Care
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1437292927 PECOS PAC ID: 6709797491 Enrollment ID: O20031124000348

Entity Name	Sutter Bay Hospitals
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1740413798 PECOS PAC ID: 3476506528 Enrollment ID: O20050517000547

Entity Name	Lpch Medical Group Div Of Lucile
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1417907940 PECOS PAC ID: 0840298543 Enrollment ID: O20061113000232

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Justin Tyler Tidwell is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Justin Tyler Tidwell, DNP, NP 300 Pasteur Dr, Stanford, CA 94305-2200 Ph: (650) 723-4000	Justin Tyler Tidwell, DNP, NP 300 Pasteur Dr, Stanford, CA 94305-2200 Ph: (650) 723-4000

Reviews and Comments

Nurse Practitioner Nurses in Stanford, CA

Angie Dee Murkins, NP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 300 Pasteur Dr, Stanford, CA 94305 Phone: 650-723-4000
Gloria Le Choi, NP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 300 Pasteur Dr, Stanford, CA 94305 Phone: 650-723-4000
Mrs. Joi Mei Soucy, NP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 300 Pasteur Dr, Stanford, CA 94305 Phone: 650-723-4000
Jangmi Baik Siverson, NP Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 300 Pasteur Dr, Stanford, CA 94305 Phone: 650-723-4000
Ambera Dedic, NP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 300 Pasteur Dr, Stanford, CA 94305 Phone: 650-723-4000
Olinda Su Mar, NP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 300 Pasteur Dr, Stanford, CA 94305 Phone: 650-723-4000
Laura Lynne Asaro, NP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 875 Blake Wilbur Dr, Clinic D, Stanford, CA 94305 Phone: 650-723-6197

Justin Tyler Tidwell, DNP, NP - Medicare Nurse Practitioner in Stanford, CA