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TYLER SLATTERY
NPI 1659802205
Podiatrist - Foot & Ankle Surgery in San Diego, CA

Active since March 24, 2017PECOS EnrolledAccepts Medicare Assignment
4077 FIFTH AVE # MER35, SAN DIEGO, CA 92103(619) 294-8111 Get Directions Write a Review

NPPES record last updated: April 2, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Apr 2, 2024, Dec 6, 2021, Mar 24, 2017 (3 updates tracked since 2017).

About Tyler Slattery NPPES

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

TYLER SLATTERY (NPI 1659802205) is an individual foot & ankle surgery provider in San Diego, California, licensed in California (E5619) and active in the NPI registry since March 2017. He is enrolled in Medicare PECOS and is a graduate of California School Of Podiatric Medicine (2017).

NPPES Registry Identity

NPI1659802205
Entity TypeIndividualMale
Primary Taxonomy213ES0103X
Provider Legal NameTYLER SLATTERY
Location Address4077 FIFTH AVE # MER35San Diego, CA 92103-2105
Mailing Address4077 Fifth Ave # Mer35San Diego, CA 92103-2105
Phone(619) 294-8111
Sole ProprietorNo
Medical School CMSCalifornia School Of Podiatric MedicineGraduated 2017
Enumeration DateMarch 24, 2017
Last NPPES UpdateApril 2, 20243 updates tracked since enumeration
NPPES CertifiedApril 2, 2024
✔ NPI 1659802205 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPodiatrist · Foot & Ankle SurgeryPodiatric Medicine & Surgery Service Providers
Taxonomy Code213ES0103X
License✔ Licensed in CA · E5619
4077 FIFTH AVE # MER35, San Diego, CA 92103
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Tyler Slattery 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 ID7214355361
PECOS Enrollment IDI20200922001340
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.

Medicare Billing Reassignment

Medicare enrollment records show Tyler Slattery reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Southern California Permanente Medical Group
1.3 mi
Health Maintenance Organization
1288 CAMINO DEL RIO N
San Diego, CA 92108
  • Reassigned Medicare billing, California enrollment
  • 13,921 clinicians in this Medicare group
NPI 1023425972 (877) 608-0044

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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.

DR. PRANAY RAG BONAGIRI DO
Internal Medicine
4077 FIFTH AVE # MER35
SAN DIEGO, CA 92103
San Diego County (619) 260-7220
ANDY M CHAN DO
Internal Medicine
4077 FIFTH AVE # MER35
SAN DIEGO, CA 92103
San Diego County (619) 294-8111
MARGARET CULVER MCDERMOTT MD
Internal Medicine
4077 FIFTH AVE # MER35
SAN DIEGO, CA 92103
San Diego County (619) 294-8111
KENNETH R STEVENS III
Internal Medicine
4077 FIFTH AVE # MER35
SAN DIEGO, CA 92103
San Diego County (503) 998-0614
CODY MITCHELL DELANEY
Internal Medicine
4077 FIFTH AVE # MER35
SAN DIEGO, CA 92103
San Diego County (619) 260-7220
JENNA LAVINA
Internal Medicine
4077 FIFTH AVE # MER35
SAN DIEGO, CA 92103
San Diego County (619) 260-7220
DR. CHRISTINA MANSOUR MD
Internal Medicine
4077 FIFTH AVE # MER35
SAN DIEGO, CA 92103
San Diego County (619) 260-7220
HAO PHUC NGUYEN D.O.
Student in an Organized Health Care Education/Training Program
4077 FIFTH AVE # MER35
SAN DIEGO, CA 92103
San Diego County (619) 260-7220

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Tyler Slattery's NPI number?

The NPI number for Tyler Slattery is 1659802205. It was assigned to this individual provider in the NPPES registry on March 24, 2017.

Where is Tyler Slattery located?

Tyler Slattery practices at 4077 Fifth Ave # Mer35, San Diego, CA 92103. The listed phone number is (619) 294-8111.

What is Tyler Slattery's specialty?

The primary specialty registered for this NPI is Podiatrist, specializing in Foot & Ankle Surgery, with taxonomy code 213ES0103X.

Is Tyler Slattery enrolled in Medicare?

Yes. Tyler Slattery is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Tyler Slattery's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Tyler Slattery reassigns Medicare benefits to Southern California Permanente Medical Group (San Diego, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Tyler Slattery's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Tyler Slattery was last updated on April 2, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years 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.