Wayne A Tillman, DPM

Primary specialty

PodiatristTaxonomy code 213E00000X

License

016004926 Issued in IL

Practice address

13011 S. 104TH Ave.
Suite 201
Palos Park, IL 60464-1512

Phone

(708) 923-0400

Fax

(708) 923-0600

NPI assigned

Nov 22, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

Other, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Advocate Good Samaritan Hospital Hospital, Downers Grove, IL, CCN 140288
• Palos Community Hospital Hospital, Palos Heights, IL, CCN 140062

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as individual

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Midwest Family and Community Resources PC

  • Community/Behavioral Health Agency
  • Hazel Crest, IL
  • NPI 1770818064
  NPD (past)
• Orland Primary Care Specialists

  • Internal Medicine Physician
  • Orland Park, IL
  • NPI 1043301245
  NPD (past)
• Podiatric Management Systems LLC

  • Primary Podiatric Medicine Podiatrist
  • Lake Zurich, IL
  • NPI 1396968053
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Advocate Health and Hospitals Corporation

  • General Acute Care Hospital
  • Downers Grove, IL
  • NPI 1578670543
  Care Compare affiliation
• Palos Community Hospital

  • Psychiatric Hospital Unit
  • Palos Heights, IL
  • NPI 1184699118
  Care Compare affiliation
• Palos Community Hospital

  • General Acute Care Hospital
  • Palos Heights, IL
  • NPI 1851386692
  Care Compare affiliation

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

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383264000000",
    "number": "1174698138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13011 S. 104TH AVE.",
            "address_2": "SUITE 201",
            "city": "PALOS PARK",
            "state": "IL",
            "postal_code": "604641512",
            "telephone_number": "708-923-0400",
            "fax_number": "708-923-0600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13011 S. 104TH AVE.",
            "address_2": "SUITE 201",
            "city": "PALOS PARK",
            "state": "IL",
            "postal_code": "604641512",
            "telephone_number": "708-923-0400",
            "fax_number": "708-923-0600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLMAN",
        "first_name": "WAYNE",
        "middle_name": "A",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-22",
        "last_updated": "2013-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "IL",
            "license": "016004926",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC",
            "identifier": "2700614",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1626136",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMGRC",
            "identifier": "4861340001",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MC",
            "identifier": "480034104",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jaclyn Ann Sullivan
• Sunrise Second Assisted Living Holdings, LLC
• Sym Palos Park SNF Healthcare LLC
• The Balanced Dietitian LLC
• Dwonna Denise Thompson, MA, LCPC
• Elton Toledo, PTA
• Danielle Ann Tsupros
• Sarah A Usmani, M.D.
• Aley Valiaparumbil
• Rugile G. Valionis, RBT

• Podiatrist in Palos Park, IL
• Providers in Palos Park, IL by specialty
• Podiatrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2013; 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.

Verify at the official NPI Registry.