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

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1225726094

Tyler M Peterson, PA-C is a Physician Assistant in Sartell, Minnesota. Qualified in 2024, 2 years ago. Practices with St Cloud Orthopedic Associates Ltd, a 44-clinician group and accepts Medicare assignment. Licensed in Minnesota.

Years since qualifying
2
Licensed in
MN
In the registry since
2023
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

1901 Connecticut Ave S
Sartell, MN 56377-2554
Phone: (320) 259-4100
Fax: (320) 257-5523
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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 14942 (MN)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X

Record details

NPI number1225726094
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedApril 28, 2023
Last updated in NPPESJuly 26, 2024
Certification dateJuly 26, 2024

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice St Cloud Orthopedic Associates Ltd — 44 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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