Active NPI
Mushina Tillman
- Contractor
- Maricopa, AZ
National Provider Identifier
1154974814
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- 8863183
- Practice address
- 19358 N Lousandra Dr
Maricopa, AZ 85138-5776 - Phone
- (708) 264-8280
- NPI assigned
- Jul 22, 2019
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Contractor | 171W00000X | 8863183 | AZ | Primary |
Addresses
Primary practice location
19358 N Lousandra Dr
Maricopa, AZ 85138-5776
Mailing address
994 S Harrison Rd
Tucson, AZ 85748-6608
Phone (520) 721-1887
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8863183 | Other | AZ | THERAPEUTIC FOSTER CARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8863183 | AZ | MD | Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1563753600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1563753600000",
"number": "1154974814",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "994 S HARRISON RD",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857486608",
"telephone_number": "520-721-1887"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "19358 N LOUSANDRA DR",
"city": "MARICOPA",
"state": "AZ",
"postal_code": "851385776",
"telephone_number": "708-264-8280"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TILLMAN",
"first_name": "MUSHINA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-07-22",
"last_updated": "2019-07-22",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Contractor",
"state": "AZ",
"license": "8863183",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "THERAPEUTIC FOSTER CARE",
"identifier": "8863183",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Maricopa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.