Active NPI
Caitlin L Tillack, ANP
- Gerontology Nurse Practitioner
- Canandaigua, NY
National Provider Identifier
1124588660
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gerontology Nurse Practitioner
- License
- 309029
- Practice address
- 401 S Main St Ste 200
Canandaigua, NY 14424-2157 - Phone
- (585) 394-1875
- Fax
- (585) 394-1878
- NPI assigned
- Mar 21, 2019
- 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 |
|---|---|---|---|---|
| Gerontology Nurse Practitioner | 363LG0600X | 309029 | NY | Primary |
Addresses
Primary practice location
401 S Main St Ste 200
Canandaigua, NY 14424-2157
Mailing address
100 Kings Hwy S
Rochester, NY 14617-5504
Phone (585) 922-1900
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | ctillack259953@direct.rochesterregional.org | Direct |
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: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
1425 Portland Ave
Rochester, NY 14621-3011
Phone (585) 922-4000
Hospital & facility affiliations
- Ur Medicine Home Care, Certified Services, Inc
- Rochester General Hospital
- F F Thompson Hospital
- Clifton Springs Hospital and Clinic
Merit-based Incentive Payment System (MIPS)
- Final score
- 96.62 of 100
- Quality
- 74.51
- Promoting interoperability
- 100
- Improvement activities
- 40
Merit-based Incentive Payment System (MIPS)
- Final score
- 96.62 of 100
- Quality
- 74.51
- Promoting interoperability
- 100
- Improvement activities
- 40
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Western New York Medical Practice P.C. | Current | Accepting new patients | |
| Rochester General Hospital | Current | Accepting new patients | |
| Rochester General Hospital | Current | Accepting new patients | |
| Rochester General Hospital | Past | Accepting new patients |
Locations
401 S Main St
Ste 200
Canandaigua, NY 14424
Phone (585) 394-1875
495 N Main St
Canandaigua, NY 14424
Phone (585) 393-3515
401 S Main St
Canandaigua, NY 14424
Phone (585) 394-1875
100 Kings Hwy S
Rochester, NY 14617
Phone (585) 922-0553
1425 Portland Ave
Rochester, NY 14621
Phone (585) 922-3122
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 and National Provider Directory roles.
-
- Family Medicine Physician
- Rochester, NY
- NPI 1356412712
-
- Family Medicine Physician
- Rochester, NY
- NPI 1063790608
-
- General Acute Care Hospital
- Rochester, NY
- NPI 1255360517
-
- General Acute Care Hospital
- Rochester, NY
- NPI 1063531929
Hospital & facility affiliations 3
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Clifton Springs, NY
- NPI 1366505463
-
- General Acute Care Hospital
- Canandaigua, NY
- NPI 1194776351
-
- Home Health Agency
- Webster, NY
- NPI 1730171547
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1553126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1742256000000",
"number": "1124588660",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 KINGS HWY S",
"city": "ROCHESTER",
"state": "NY",
"postal_code": "146175504",
"telephone_number": "585-922-1900",
"fax_number": "585-922-0636"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "401 S MAIN ST STE 200",
"city": "CANANDAIGUA",
"state": "NY",
"postal_code": "144242157",
"telephone_number": "585-394-1875",
"fax_number": "585-394-1878"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TILLACK",
"first_name": "CAITLIN",
"middle_name": "L",
"credential": "ANP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-03-21",
"last_updated": "2025-03-18",
"certification_date": "2025-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "363LG0600X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Gerontology",
"state": "NY",
"license": "309029",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "ctillack259953@direct.rochesterregional.org",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "401 S Main St Ste 200",
"city": "Canandaigua",
"state": "NY",
"country_code": "US",
"postal_code": "144242157",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Canandaigua, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2025; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.