Individual provider Active NPI

Tirso A Castillo, MD

  • Gastroenterology Physician
  • Dublin, GA
National Provider Identifier
1083692560
Registry record updated Jul 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
048883 Issued in GA
Practice address
111 Fairview Park Dr
Dublin, GA 31021-2501
Phone
(478) 272-1366
Fax
(478) 275-2322
NPI assigned
Jan 5, 2006
Last updated
Jul 12, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2023

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 048883 GA Primary

Addresses

Primary practice location

111 Fairview Park Dr
Dublin, GA 31021-2501

Mailing address

PO Box 1528
Dublin, GA 31040-1528
Phone (478) 272-1366

Other practice location 1

677 Church St NE
Marietta, GA 30060-1101
Phone (470) 267-1760

Other identifiers 5

IdentifierTypeStateIssuer
52420599-002OtherGABCBS
4653853OtherGAAETNA
1007287OtherGAUNITED HEALTHCARE
681242OtherGAFIRST HEALTH
000872066AMedicaidGA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tcastillo524218@directwellstar.org Health Information Exchange (HIE)

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100208000314 GA Practitioner - Gastroenterology 6901949395 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
93.93 of 100Reported as apm
Quality
82.14
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
048883GAMDGastroenterology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dublin Internal Medicine Current Accepting new patients
Wellstar Medical Group, LLC CurrentSince Mar 15, 2023 Accepting new patients
Dim Physicians LLC Current Accepting new patients
Wellstar Medical Group, LLC Current Accepting new patients

Locations

104 Fairview Park Dr
Dublin, GA 31021
Phone (478) 272-1366

200 Industrial Blvd
Dublin, GA 31021
Phone (478) 274-3865

5150 Stilesboro Rd NW
Ste 220
Kennesaw, GA 30152
Phone (770) 424-8222

677 Church St NE
Marietta, GA 30060
Phone (770) 793-5435

Interoperability endpoints

  • Direct secure messaging: tirso.castillo@mrmc.gadirect.net

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1136419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689120000000",
    "number": "1083692560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1528",
            "city": "DUBLIN",
            "state": "GA",
            "postal_code": "310401528",
            "telephone_number": "478-272-1366",
            "fax_number": "478-275-2322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 FAIRVIEW PARK DR",
            "city": "DUBLIN",
            "state": "GA",
            "postal_code": "310212501",
            "telephone_number": "478-272-1366",
            "fax_number": "478-275-2322"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "677 Church St NE",
            "address_purpose": "LOCATION",
            "city": "Marietta",
            "state": "GA",
            "postal_code": "300601101",
            "country_code": "US",
            "telephone_number": "470-267-1760",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CASTILLO",
        "first_name": "TIRSO",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-05",
        "last_updated": "2023-07-12",
        "certification_date": "2023-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "GA",
            "license": "048883",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "52420599-002",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4653853",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "1007287",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST HEALTH",
            "identifier": "681242",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000872066A",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tcastillo524218@directwellstar.org",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "677 Church St NE",
            "city": "Marietta",
            "state": "GA",
            "country_code": "US",
            "postal_code": "300601101",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Dublin, GA

Sources for this page

Verify at the official NPI Registry.