JACK TYSON
NPI 1770428179
Registered Nurse in Brooklyn, NY
About Jack Tyson NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
JACK TYSON (NPI 1770428179) is an individual registered nurse in Brooklyn, New York, licensed in New York (N32590) and active in the NPI registry since April 2026. He is enrolled in Medicare PECOS and is a graduate of Other (2025).
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Jack Tyson is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Jack Tyson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Brooklyn, NY 11201
- Reassigned Medicare billing, New York enrollment
- 105 clinicians in this Medicare group
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.
BROOKLYN, NY 11201
BROOKLYN, NY 11201
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 Jack Tyson's NPI number?
The NPI number for Jack Tyson is 1770428179. It was assigned to this individual provider in the NPPES registry on April 21, 2026.
Where is Jack Tyson located?
Jack Tyson practices at 40 Flatbush Avenue Ext, Brooklyn, NY 11201. The listed phone number is (718) 215-1818.
What is Jack Tyson's specialty?
The primary specialty registered for this NPI is Registered Nurse with taxonomy code 163W00000X.
Is Jack Tyson enrolled in Medicare?
Yes. Jack Tyson is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Jack Tyson's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Jack Tyson reassigns Medicare benefits to Community Health Project, Inc. (Brooklyn, NY). 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 Jack Tyson'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 Jack Tyson was last updated on April 21, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.
# Jack Tyson · NPI 1770428179
Registered Nurse provider in Brooklyn, New York. Individual provider, active in the CMS NPPES registry since April 21, 2026.
## Identity
- **NPI:** 1770428179 (Entity type: Individual)
- **Enumerated:** April 21, 2026
- **Primary specialty:** Registered Nurse · taxonomy 163W00000X
- **State license:** N32590 (New York)
- **Sole proprietor:** No
## Practice location
- **Address:** 40 FLATBUSH AVENUE EXT, Brooklyn, NY 11201-2903
- **Phone:** (718) 215-1818
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** Community Health Project, Inc. (NPI 1659061489, Brooklyn, NY), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2025
## Record status
- **NPPES last updated:** April 21, 2026
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Source: [NPI Profile](https://npiprofile.com/npi/1770428179) · Data from the CMS NPPES public registry.