Sally E. Decastro-Tilsen, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA 10296 Issued in CA

Practice address

400 Newport Center Dr Ste 701
Newport Beach, CA 92660-7608

Phone

(949) 759-8001

Fax

(949) 760-3671

NPI assigned

Apr 22, 2008

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Sally Tilsen Other name

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 1977

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

C Philip O Carroll M D IncGroup PAC ID 9234326778, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• Direct secure messaging: sally.tilsenpa.p64@direct.nautilus.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• C Philip O Carroll M D Inc

  • Neurological Surgery Physician
  • Newport Beach, CA
  • NPI 1619287646
  Medicare reassignment Care Compare group

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1208822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208822400000",
    "number": "1023282019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 WHITE SAILS WAY",
            "city": "CORONA DEL MAR",
            "state": "CA",
            "postal_code": "926251524",
            "telephone_number": "949-378-8641",
            "fax_number": "949-760-3671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 NEWPORT CENTER DR STE 701",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926607608",
            "telephone_number": "949-759-8001",
            "fax_number": "949-760-3671"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DECASTRO-TILSEN",
        "first_name": "SALLY",
        "middle_name": "E.",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-22",
        "last_updated": "2008-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA 10296",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA 10296",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SALLY",
            "last_name": "TILSEN",
            "credential": "P.A.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Alecia Deangelis, PMHNP
• August Anthony Deangelo III
• Deanne Brown Professional Clinical Counselor PC
• Darcy Debernarde, LE, COE
• Deborah C, Henry, M.D., Apc
• Carley Flam Decker, PHD
• Margaret Mary Decker, PH.D.
• Mohannad Deek
• Jodi Marie Deemer, MSN, AGPCNP
• Jennifer Defrain, MS, RD

• Physician Assistant in Newport Beach, CA
• Providers in Newport Beach, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.