Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Ty Martin Roseberry, PA

Individual provider Physician Assistant · NPI 1487604948

Mr. Ty Martin Roseberry, PA is a Physician Assistant in Indianapolis, Indiana. Qualified in 2003, 23 years ago. Practices with Southern California Permanente Medical Group, an 11,242-clinician group and accepts Medicare assignment. Licensed in California and Indiana.

Years since qualifying
23
Licensed in
CA, IN
In the registry since
2006
Specialties on file
2
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

1801 N Senate Blvd #200
Indianapolis, IN 46202-1228
Phone: (317) 802-2000
Fax: (317) 924-0115
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 19182 (CA)
Physician Assistant Taxonomy 363A00000X · Licence 10000768A (IN)

Record details

NPI number1487604948
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedMay 12, 2006
Last updated in NPPESNovember 29, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2003 (23 years in practice)
Group practice Southern California Permanente Medical Group — 11242 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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