NPIMap

Individual provider Active NPI

William C Tidmore Jr., M.D.

  • Rheumatology Physician
  • Valdosta, GA
National Provider Identifier
1073695292
Registry record updated Sep 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rheumatology PhysicianTaxonomy code 207RR0500X
License
041978 Issued in GA
Practice address
2418 N Oak St
Valdosta, GA 31602-2576
Phone
(229) 219-0247
Fax
(229) 219-0837
NPI assigned
Oct 19, 2006
Last updated
Sep 8, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rheumatology Physician 207RR0500X 041978 GA Primary

Addresses

Primary practice location

2418 N Oak St
Valdosta, GA 31602-2576

Mailing address

2418 N Oak St
Valdosta, GA 31602-2576
Phone (229) 219-0247

Other practice location 1

39 Kent Rd Ste 2
Tifton, GA 31794-1697
Phone (229) 244-1400

Other practice location 2

2412 N Oak St
Valdosta, GA 31602-2567
Phone (229) 244-1400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20081003000506 GA Practitioner - Rheumatology 5294723987 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Rheumatology
Education
Emory University School of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Valdosta Family Medicine Associates, P.C.Group PAC ID 5991791683, 37 clinicians
Select Rehabilitation, LLCGroup PAC ID 9032020490, 1,935 clinicians

Practice addresses (Care Compare)

2412 N Oak St
Valdosta, GA 31602-2567
Phone (229) 244-1400

2600 Compass Rd
Glenview, IL 60026-8001

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Valdosta Family Medicine Associates, P.C. Rheumatology CurrentSince Aug 24, 2000 Accepting new patients
Hospital Authority of the City of Bainbridge and Decatur County Past Accepting new patients

Locations

816 Love Ave
Tifton, GA 31794

2412 N Oak St
Valdosta, GA 31602
Phone (229) 244-1400

2418 N Oak St
Valdosta, GA 31602
Phone (229) 289-1517

2418 N Oak St
Ste C
Valdosta, GA 31602
Phone (229) 219-0700

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CHFDAA
  • Direct secure messaging: william.tidmore@vfmapc.eclinicaldirectplus.com

Organizations & group practices 3

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 6

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": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599523200000",
    "number": "1073695292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2418 N OAK ST",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316022576",
            "telephone_number": "229-219-0247",
            "fax_number": "229-219-0837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2418 N OAK ST",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316022576",
            "telephone_number": "229-219-0247",
            "fax_number": "229-219-0837"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "39 Kent Rd Ste 2",
            "address_purpose": "LOCATION",
            "city": "Tifton",
            "state": "GA",
            "postal_code": "317941697",
            "country_code": "US",
            "telephone_number": "229-244-1400",
            "fax_number": "229-244-5512",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2412 N Oak St",
            "address_purpose": "LOCATION",
            "city": "Valdosta",
            "state": "GA",
            "postal_code": "316022567",
            "country_code": "US",
            "telephone_number": "229-244-1400",
            "fax_number": "229-244-5512",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TIDMORE",
        "first_name": "WILLIAM",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-19",
        "last_updated": "2020-09-08",
        "certification_date": "2020-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RR0500X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Rheumatology",
            "state": "GA",
            "license": "041978",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Valdosta, GA

Sources for this page

Verify at the official NPI Registry.