Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Tyler Gregory Rose, PA-C

Individual provider Medical Physician Assistant · NPI 1386213916

Tyler Gregory Rose, PA-C is a Physician Assistant in Providence, Rhode Island. Qualified in 2021, 5 years ago. Practices with Affinity Physicians LLC, a 734-clinician group, works from 3 locations and accepts Medicare assignment. Licensed in Rhode Island.

Years since qualifying
5
Licensed in
RI
In the registry since
2021
Specialties on file
2
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

825 Chalkstone Ave
Providence, RI 02908-4728
Phone: (401) 456-2121
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (2)

  • 101 Dudley St, Providence, RI 02905-2401 — (401) 274-1122
  • 455 Toll Gate Rd, Warwick, RI 02886-2759 — (401) 737-7010

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA01345 (RI)
Medical Physician Assistant Taxonomy 363AM0700X

Record details

NPI number1386213916
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedJune 18, 2021
Last updated in NPPESJune 20, 2024
Certification dateJune 20, 2024
Mailing address459 East Ave # 3f, Pawtucket, RI 02860-7606

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Affinity Physicians Llc. — 734 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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