Active NPI
Elizabeth Tillem, MD
- Emergency Medicine Physician
- Bronx, NJ
National Provider Identifier
1093860504
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 225727
- Practice address
- 1650 Grand Concourse
Dept of Emergency Medicine
Bronx, NJ 10456 - Phone
- (718) 518-5046
- NPI assigned
- Jan 24, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 225727 | NY | Primary |
Addresses
Primary practice location
1650 Grand Concourse
Dept of Emergency Medicine
Bronx, NJ 10456
Mailing address
1650 Grand Concourse
Dept of Emergency Medicine
Bronx, NJ 10456
Phone (718) 518-5046
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bronxcare Health System | Emergency Medicine | Current | Accepting new patients |
Locations
1276 Fulton Ave
Rm 208
Bronx, NY 10456
Phone (718) 901-8918
1650 Grand Concourse
Bronx, NY 10457
Phone (718) 294-7104
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169596800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1093860504",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1650 GRAND CONCOURSE",
"address_2": "DEPT OF EMERGENCY MEDICINE",
"city": "BRONX",
"state": "NJ",
"postal_code": "10456",
"telephone_number": "718-518-5046"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1650 GRAND CONCOURSE",
"address_2": "DEPT OF EMERGENCY MEDICINE",
"city": "BRONX",
"state": "NJ",
"postal_code": "10456",
"telephone_number": "718-518-5046"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TILLEM",
"first_name": "ELIZABETH",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "NY",
"license": "225727",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Bronx, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.