NPIMap

Individual provider Active NPI

Donald Gregory Tisdale Jr., NP

  • Family Nurse Practitioner
  • Flowood, MS
National Provider Identifier
1174006522
Registry record updated May 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
902899 Issued in MS
Practice address
10 Canebrake Blvd Ste 110-09
Flowood, MS 39232-2211
Phone
(769) 333-8808
Fax
(769) 333-8809
NPI assigned
Sep 12, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 26, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 902899 MS Primary

Addresses

Primary practice location

10 Canebrake Blvd Ste 110-09
Flowood, MS 39232-2211

Mailing address

10 Canebrake Blvd Ste 110-09
Flowood, MS 39232-2211
Phone (769) 333-8808

Other practice location 1

1227 N State St Ste 101
Jackson, MS 39202-2002
Phone (601) 355-2485

Other names 1

  • Greg Tisdfale Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
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
I20190307003176 MS Practitioner - Nurse Practitioner 2062751076 Reassigns benefits to 4 organizations

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
On-Site Health LLCGroup PAC ID 1658770953, 2 clinicians

Practice addresses (Care Compare)

120 Stone Creek Blvd
Suite 300
Flowood, MS 39232-8211
Phone (769) 333-8808

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Iris Medical Group Family CurrentSince Dec 8, 2024 Accepting new patients
On-Site Health LLC Family CurrentSince Apr 27, 2021 Accepting new patients
Wound Management Specialists, LLC CurrentSince Dec 6, 2024 Accepting new patients
Healthcare Plus Limited Liability Company CurrentSince Aug 1, 2025 Accepting new patients
Winston Medical Clinic LLC Past Accepting new patients

Locations

2781 C T Switzer SR Dr
Ste 100
Biloxi, MS 39531
Phone (228) 207-8632

120 Stone Creek Blvd
Ste 300
Flowood, MS 39232
Phone (601) 586-7070

120 Stone Creek Blvd
Flowood, MS 39232
Phone (601) 822-2294

10 Canebrake Blvd
Ste 11009
Flowood, MS 39232
Phone (769) 333-8808

660 Lakeland East Dr
Ste 106
Flowood, MS 39232
Phone (769) 333-8808

778 Liberty Rd
Flowood, MS 39232
Phone (601) 914-9620

1190 N State St
Ste 2A
Jackson, MS 39202
Phone (601) 292-4292

Interoperability endpoints

  • Direct secure messaging: donald.tisdale.1@30029.direct.athenahealth.com
  • Direct secure messaging: donald.tisdale.2@24074.direct.athenahealth.com

Organizations & group practices 5

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 7

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": "1536710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621987200000",
    "number": "1174006522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 CANEBRAKE BLVD STE 110-09",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392322211",
            "telephone_number": "769-333-8808",
            "fax_number": "769-333-8809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 CANEBRAKE BLVD STE 110-09",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392322211",
            "telephone_number": "769-333-8808",
            "fax_number": "769-333-8809"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1227 N State St Ste 101",
            "address_purpose": "LOCATION",
            "city": "Jackson",
            "state": "MS",
            "postal_code": "392022002",
            "country_code": "US",
            "telephone_number": "601-355-2485",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TISDALE",
        "first_name": "DONALD",
        "middle_name": "GREGORY",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-09-12",
        "last_updated": "2021-05-26",
        "certification_date": "2021-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "902899",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GREG",
            "last_name": "TISDFALE",
            "credential": "NP",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Flowood, MS

Sources for this page

Verify at the official NPI Registry.