Ethan Tillotson, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

25270 Issued in MS

Practice address

1665 S Green St
Tupelo, MS 38804-6556

Phone

(662) 377-2189

NPI assigned

Jun 20, 2016

Sex

Male

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 MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

University of Mississippi School of Medicine, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

North Mississippi Faculty Practice Plan LLCGroup PAC ID 2961658950, 8 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• North Mississippi Medical Ctr HHA Home health agency, Tupelo, MS, CCN 257002
• North Mississippi Medical Center Hospital, Tupelo, MS, CCN 250004

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ethantillotson@nmhs.medalliesdirect.net

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.

• North Mississippi Faculty Practice Plan LLC

  dba Family Medicine Residency Center

  • Family Medicine Physician
  • Tupelo, MS
  • NPI 1255692356
  Medicare reassignment Care Compare group NPD
• Clay County Medical Corporation

  dba Clay County Med Ctr - ER Phys

  • Emergency Care Clinic/Center
  • West Point, MS
  • NPI 1578670972
  Medicare reassignment
• North Mississippi Medical Center

  • General Acute Care Hospital
  • Tupelo, MS
  • NPI 1376969683
  NPD
• North Mississippi Faculty Practice

  • Family Medicine Physician
  • Tupelo, MS
  • NPI 1912268590
  NPD (past)
• North Mississippi Medical Center, Inc.

  dba North Mississippi Medical Center

  • General Acute Care Hospital
  • Tupelo, MS
  • NPI 1598875460
  NPD (past)

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

• North Mississippi Medical Center, Inc.

  dba North MS Medical Center Home Health Agency

  • Home Health Agency
  • Tupelo, MS
  • NPI 1003871344
  Care Compare affiliation
• North Mississippi Medical Center, Inc.

  dba North Mississippi Medical Center

  • General Acute Care Hospital
  • Tupelo, MS
  • NPI 1598875460
  Care Compare affiliation

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

{
    "created_epoch": "1466380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655683200000",
    "number": "1194175273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1665 S GREEN ST",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388046556",
            "telephone_number": "662-377-2189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1665 S GREEN ST",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388046556",
            "telephone_number": "662-377-2189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLOTSON",
        "first_name": "ETHAN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-20",
        "last_updated": "2022-06-20",
        "certification_date": "2022-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "25270",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deidra N Thrasher
• Abigail Tidwell, OTD, OTR
• Elesha P Tidwell, FNP
• Tanya Tigner
• Eric Wade Tillotson
• Madison Nash Timmons
• Terry V Timmons, LPC
• Tina Dye Counseling, PLLC
• James Paul Tinsley
• Sylvia D Tisdale-McIntosh

• Family Medicine Physician in Tupelo, MS
• Providers in Tupelo, MS by specialty
• Family Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2022; 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.