TYLER BRUECKMAN PA-C
NPI 1417780545
Physician Assistant in Dayton, OH

Q: What is Tyler Brueckman's NPI number?

The NPI number for Tyler Brueckman is 1417780545. It was assigned to this individual provider in the NPPES registry on August 23, 2024.

Q: What is Tyler Brueckman's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Q: When was this NPI record last updated?

The NPPES record for Tyler Brueckman was last updated on October 13, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since August 23, 2024PECOS EnrolledAccepts Medicare Assignment

3205 WOODMAN DR, DAYTON, OH 45420(937) 298-4417(937) 298-8260 Get Directions Write a Review

NPPES record last updated: October 13, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Oct 9, 2025, Aug 23, 2024 (2 updates tracked since 2024).

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About Tyler Brueckman Pa-c NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TYLER BRUECKMAN PA-C (NPI 1417780545) is an individual physician assistant in Dayton, Ohio, licensed in Ohio (50-008947) and active in the NPI registry since August 2024. He is enrolled in Medicare PECOS, is affiliated with Miami Valley Hospital, and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1417780545

Entity TypeIndividualMale

Primary Taxonomy363A00000X

Provider Legal NameTYLER BRUECKMANCredential: PA-C

Location Address3205 WOODMAN DRDayton, OH 45420-1143

Mailing Address6480 Harrison Ave Ste 201Cincinnati, OH 45247-7961 · (513) 713-1779 · Fax (513) 854-9921

Phone(937) 298-4417

Fax(937) 298-8260

Sole ProprietorYes

Medical School CMSOtherGraduated 2024

Enumeration DateAugust 23, 2024

Last NPPES UpdateOctober 13, 20252 updates tracked since enumeration

NPPES CertifiedOctober 13, 2025

✔ NPI 1417780545 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363A00000X

License✔ Licensed in OH · 50-008947

Definition

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

3205 WOODMAN DR, Dayton, OH 45420

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Secondary Practice Locations 2

Location 170 Weller DrTipp City, OH 45371-3306 · Phone (937) 669-0909 · Fax (937) 669-4050

Location 22066 W Main St Ste 130Xenia, OH 45385-2882 · Phone (937) 372-7583

Other Identifiers 1

Medicaid0080432OH

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include CareSource, MedMutual.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Tyler Brueckman Pa-c is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8729511811

PECOS Enrollment IDI20241028003434

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Miami Valley Hospital

Acute Care Hospitals · Dayton, OH

3/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number360051

LocationOne Wyoming StreetDayton, OH 45409 · Montgomery County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 45420 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$84.72 typical visit price

range $54.34 – $166.65

Typical copayment $21.18 (range $13.58 – $41.66)

Most-billed visit code 99203

Established Patient

$68.07 typical visit price

range $17.10 – $135.40

Typical copayment $17.01 (range $4.27 – $33.85)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. AMY ELISHA BERNARD ATC, NASM-PES

Specialist/Technologist (Athletic Trainer)

3205 WOODMAN DR
KETTERING, OH 45420

Montgomery County (937) 531-6785

PAUL ANTHONY NITZ MD

Orthopaedic Surgery