Kylea Marie Tibbs-Hnizdo, D.M.D

Primary specialty

DentistTaxonomy code 122300000X

License

019028844 Issued in IL

Practice address

2239 E Cook St
Springfield, IL 62703-1944

Phone

(217) 788-2300

Fax

(217) 788-2342

NPI assigned

Sep 30, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Cass County Public Health Dept

  • Federally Qualified Health Center (FQHC)
  • Virginia, IL
  • NPI 1164596375

  IL

  Medicare reassignment NPD
• Cass County Public Health Dept

  • State or Local Public Health Clinic/Center
  • Virginia, IL
  • NPI 1871555193
  NPD
• Cass County Public Health Dept

  • Federally Qualified Health Center (FQHC)
  • Beardstown, IL
  • NPI 1942439310
  NPD

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

{
    "created_epoch": "1317340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490659200000",
    "number": "1174807705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 S 9TH ST",
            "city": "PETERSBURG",
            "state": "IL",
            "postal_code": "626751621",
            "telephone_number": "217-415-2426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2239 E COOK ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627031944",
            "telephone_number": "217-788-2300",
            "fax_number": "217-788-2342"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIBBS-HNIZDO",
        "first_name": "KYLEA",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "D.M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-30",
        "last_updated": "2017-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019028844",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brock Daniel Thornton
• Carrie F Thornton
• Cole Heath Thornton, ATC, PES
• Gabrielle Thro
• Audrey Thursby, DNP, AGPCBP-BC
• Daniela Tierrablanca Mendoza
• Ashley Nicole Till, OTR/L
• Gretchen Till, MOTOTRL
• Nicholas M. Till, CRNA
• Jennifer Lynn Tillberg-McCoy, CRNA

• All providers in Springfield, IL
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2017; 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.

Verify at the official NPI Registry.