NPIMap

Individual provider Active NPI

Clifford Randolph Tillman

  • Gastroenterology Physician
  • Vidalia, LA
National Provider Identifier
1053309732
Registry record updated Jul 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
06980R Issued in LA
Practice address
107 Front St
Suite 2126
Vidalia, LA 71373-2836
Phone
(318) 336-2216
Fax
(318) 336-6074
NPI assigned
Oct 7, 2005
Last updated
Jul 25, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 06980R LA Primary

Addresses

Primary practice location

107 Front St
Suite 2126
Vidalia, LA 71373-2836

Mailing address

107 Front St
Suite 2126
Vidalia, LA 71373-2836
Phone (318) 336-2216

Other identifiers 2

IdentifierTypeStateIssuer
1316521MedicaidLA
0115585MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA, MS, AL, GA4 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
I20040217000951 LA Practitioner - Internal MedicinePractitioner - Gastroenterology 9830084060 Reassigns benefits to 3 organizations
Practice locations: Vidalia, LA
I20110525000733 MS Practitioner - Internal MedicinePractitioner - Gastroenterology 9830084060 Reassigns benefits to 1 organization
Practice locations: Tylertown, MS; Natchez, MS; Monticello, MS; Meadville, MS
I20240327000300 AL Practitioner - Gastroenterology 9830084060 Reassigns benefits to 2 organizations
I20260106003297 GA Practitioner - Gastroenterology 9830084060 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Gastroenterology
Education
Other, 1972
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lasalle Parish Hospital Service Dist No1Group PAC ID 6709781545, shared by 5 NPIs, 22 clinicians
Ochsner Clinic LLCGroup PAC ID 8224933619, 2,845 clinicians
Imc-Diagnostic and Medical Clinic LLCGroup PAC ID 2860399623, 168 clinicians

Practice addresses (Care Compare)

1102 N Pine Rd
Olla, LA 71465-4804
Phone (318) 495-3131

1514 Jefferson Hwy
New Orleans, LA 70121-2429
Phone (504) 842-3000

1700 Springhill Ave
Suite 100
Mobile, AL 36604-1416
Phone (251) 435-1200

2000 Pepperell Pkwy
Opelika, AL 36801-5452
Phone (334) 528-6655

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy396
Upper gastrointestinal (GI) endoscopy for acid reflux369

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R807638MSMDFamily Nurse Practitioner
11744TNMDObstetrics & Gynecology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Ochsner Clinic LLC Internal Medicine CurrentSince Sep 25, 2025 Accepting new patients
Lasalle Parish Hospital Service District #1 CurrentSince Apr 2, 2018 Accepting new patients
Singing River Health System CurrentSince Mar 5, 2025 Accepting new patients
Lasalle Parish Hospital Service District #1 Current Accepting new patients
Ochsner Clinic LLC CurrentSince Sep 25, 2025 Accepting new patients
Magnolia Senior Care LLC Current Accepting new patients
Imc-Diagnostic and Medical Clinic LLC Internal Medicine CurrentSince Apr 1, 2024 Accepting new patients
Ochsner Clinic LLC Current Accepting new patients
Imc-Diagnostic and Medical Clinic LLC CurrentSince Apr 1, 2024 Accepting new patients
Lasalle Parish Hospital Service Dist No1 CurrentSince Feb 3, 2020 Accepting new patients
Piedmont Specialty Hospital Billing LLC Internal Medicine CurrentSince Nov 29, 2025 Accepting new patients
Tillman Medical Group PA Current Accepting new patients
Professional Rehabilitation Hospital LLC Past Accepting new patients
Natchez Community Hospital LLC PastSince Oct 2, 2008 Accepting new patients
Lasalle Parish Hospital Service District #1 Past Accepting new patients
Lasalle Hospital Service Dist #1 Past Accepting new patients

Locations

1700 Spring Hill Ave
Ste 100
Mobile, AL 36604

1133 Eagles Landing Pkwy
Stockbridge, GA 30281
Phone (678) 604-1000

4430 Veterans Memorial Blvd
Metairie, LA 70006
Phone (504) 433-7203

1514 Jefferson Hwy
New Orleans, LA 70121

1049 N Pine Rd
Olla, LA 71465
Phone (318) 495-3175

1102 N Pine Rd
Olla, LA 71465
Phone (318) 495-5302

120 Ochsner Blvd
Terrytown, LA 70056
Phone (504) 595-8020

3109 Bienville Blvd
Ocean Springs, MS 39564
Phone (228) 818-1100

2809 Denny Ave
Pascagoula, MS 39581
Phone (228) 809-5000

Interoperability endpoints

  • Direct secure messaging: ctillman194698@directinfirmaryhealth.org

Ownership & related parties

All facility ownership & control disclosures 5

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Riverbridge Specialty HospitalVidalia, LA, CCN 192028 Hospital 5% Or Greater Direct Ownership Interest (22%) Dec 15, 2007
Riverbridge Specialty HospitalVidalia, LA, CCN 19TA28 Hospital 5% Or Greater Direct Ownership Interest (22%) Dec 15, 2007
Lexington Manor Senior Care LLCLexington, MS, CCN 255091 Skilled nursing facility 5% Or Greater Indirect Ownership Interest (99%)
Adp of the SNF		 Jan 1, 2017
Aug 1, 2007
Billdora Senior Care LLCTylertown, MS, CCN 255243 Skilled nursing facility 5% Or Greater Indirect Ownership Interest (99%)
Adp of the SNF
Indirect Ownership Interest (99%)		 Jan 1, 2017
Aug 1, 2007
Jan 1, 2017
Magnolia Senior Care LLCJackson, MS, CCN 255275 Skilled nursing facility 5% Or Greater Indirect Ownership Interest (99%)
Adp of the SNF		 Jan 1, 2017
Jan 1, 2015

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 17

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.

View all 17

Hospital & facility affiliations 8

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": "1128643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1216944000000",
    "number": "1053309732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 FRONT ST",
            "address_2": "SUITE 2126",
            "city": "VIDALIA",
            "state": "LA",
            "postal_code": "713732836",
            "telephone_number": "318-336-2216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 FRONT ST",
            "address_2": "SUITE 2126",
            "city": "VIDALIA",
            "state": "LA",
            "postal_code": "713732836",
            "telephone_number": "318-336-2216",
            "fax_number": "318-336-6074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLMAN",
        "first_name": "CLIFFORD",
        "middle_name": "RANDOLPH",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-07",
        "last_updated": "2008-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "LA",
            "license": "06980R",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1316521",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0115585",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vidalia, LA

Sources for this page

Verify at the official NPI Registry.