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Individual provider Active NPI

Kristen Tillquist, DO

  • Nephrology Physician
  • Riverside, RI
National Provider Identifier
1033774559
Registry record updated Mar 5, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
DO01349 Issued in RI
Practice address
375 Wampanoag TRL
Riverside, RI 02915-2232
Phone
(401) 649-4060
Fax
(401) 649-4061
NPI assigned
May 9, 2019
Last updated
Mar 5, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology Physician 207RN0300X DO01349 RI Primary

Addresses

Primary practice location

375 Wampanoag TRL
Riverside, RI 02915-2232

Mailing address

15 La Salle SQ
Providence, RI 02903-1814
Phone (401) 444-6779

Other practice location 1

250 Centerville Rd Bldg E
Warwick, RI 02886-4400
Phone (401) 649-4060

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in RI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240612002573 RI Practitioner - Nephrology 4183951304 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nephrology
Education
West Virginia School of Osteopathic Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Brown MedicineGroup PAC ID 0446159776, 220 clinicians
Lifespan Physician Group IncGroup PAC ID 2567455082, 1,151 clinicians

Practice addresses (Care Compare)

250 Centerville Rd
BLDG E
Warwick, RI 02886-4400
Phone (401) 490-3838

375 Wampanoag TRL
Riverside, RI 02915-2232
Phone (401) 649-4000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Brown Medicine CurrentSince Aug 1, 2024 Accepting new patients
Lifespan Physician Group, Inc. CurrentSince Jan 1, 2026 Accepting new patients
Brown Medicine Internal Medicine Current Accepting new patients
Lifespan Physician Group Inc CurrentSince Jan 1, 2026 Accepting new patients
Brown Medicine Nephrology CurrentSince Aug 1, 2024 Accepting new patients

Locations

185A High Service Ave
North Providence, RI 02904
Phone (401) 354-6050

110 Elm St
Providence, RI 02903
Phone (401) 443-4992

15 La Salle Sq
Providence, RI 02903

593 Eddy St
Providence, RI 02903

375 Wampanoag Trl
Riverside, RI 02915
Phone (401) 649-4010

455 Toll Gate Rd
Warwick, RI 02886
Phone (401) 737-7000

Organizations & group practices 6

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

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1557360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772668800000",
    "number": "1033774559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 LA SALLE SQ",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029031814",
            "telephone_number": "401-444-6779",
            "fax_number": "401-444-6912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 WAMPANOAG TRL",
            "city": "RIVERSIDE",
            "state": "RI",
            "postal_code": "029152232",
            "telephone_number": "401-649-4060",
            "fax_number": "401-649-4061"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "250 Centerville Rd Bldg E",
            "address_purpose": "LOCATION",
            "city": "Warwick",
            "state": "RI",
            "postal_code": "028864400",
            "country_code": "US",
            "telephone_number": "401-649-4060",
            "fax_number": "401-649-4061",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TILLQUIST",
        "first_name": "KRISTEN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-09",
        "last_updated": "2026-03-05",
        "certification_date": "2026-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "RI",
            "license": "DO01349",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, RI

Sources for this page

Verify at the official NPI Registry.