TYLER CLACK CRNA
NPI 1891407136
Nurse Anesthetist, Certified Registered in Traverse City, MI
About Tyler Clack Crna NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
TYLER CLACK CRNA (NPI 1891407136) is an individual nurse anesthetist, certified registered in Traverse City, Michigan, licensed in Michigan (4704339380) and active in the NPI registry since December 2022. He is affiliated with Munson Medical Center and is a graduate of Other (2022).
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
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 Clack Crna 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.
Medicare Billing Reassignments
2Medicare enrollment records show Tyler Clack reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Traverse City, MI 49684
- Reassigned Medicare billing, Michigan enrollment
- 74 clinicians in this Medicare group
Traverse City, MI 49684
- Reassigned Medicare billing, Michigan enrollment
- 191 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.
Hospital Affiliations CMS Care Compare 2
Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.
Munson Medical Center
Acute Care Hospitals · Traverse City, MIKalkaska Memorial Health Center
Critical Access Hospitals · Kalkaska, MIPhysician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 49684 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
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.
TRAVERSE CITY, MI 49684
TRAVERSE CITY, MI 49684
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 Clack's NPI number?
The NPI number for Tyler Clack is 1891407136. It was assigned to this individual provider in the NPPES registry on December 19, 2022.
Where is Tyler Clack located?
Tyler Clack practices at 1105 6th St, Traverse City, MI 49684. The listed phone number is (231) 935-5000.
What is Tyler Clack's specialty?
The primary specialty registered for this NPI is Nurse Anesthetist, Certified Registered with taxonomy code 367500000X.
Is Tyler Clack enrolled in Medicare?
Yes. Tyler Clack 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 organizations bill Medicare for Tyler Clack's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Tyler Clack reassigns Medicare benefits to 2 organizations: Munson Medical Center (Traverse City, MI) and Munson Medical Group (Traverse City, MI). Each 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 Clack's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
Is Tyler Clack affiliated with any hospitals?
According to CMS data, Tyler Clack is affiliated with Munson Medical Center and Kalkaska Memorial Health Center.
When was this NPI record last updated?
The NPPES record for Tyler Clack was last updated on December 19, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.
# Tyler Clack, CRNA · NPI 1891407136
Nurse Anesthetist, Certified Registered physician in Traverse City, Michigan. Individual provider, active in the CMS NPPES registry since December 19, 2022.
## Identity
- **NPI:** 1891407136 (Entity type: Individual)
- **Enumerated:** December 19, 2022
- **Primary specialty:** Nurse Anesthetist, Certified Registered · taxonomy 367500000X
- **State license:** 4704339380 (Michigan)
- **Sole proprietor:** Yes
## Practice location
- **Address:** 1105 6TH ST, Traverse City, MI 49684-2345
- **Phone:** (231) 935-5000
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Bills Medicare through:** 2 organizations under Medicare reassignment (form CMS-855R): Munson Medical Center (NPI 1710735287, Traverse City, MI); Munson Medical Group (NPI 1972225571, Traverse City, MI) · CMS Revalidation Reassignment List, October 2026 release
- **Medical school:** Other, class of 2022
## Record status
- **NPPES last updated:** December 19, 2022
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Source: [NPI Profile](https://npiprofile.com/npi/1891407136) · Data from the CMS NPPES public registry.