NPIMap

Individual provider Active NPI

Rebecca Tillotson, PA

  • Physician Assistant
  • Dryden, NY
National Provider Identifier
1194703488
Registry record updated Mar 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
005551 Issued in NY
Practice address
5 Evergreen St.
Dryden, NY 13053-0008
Phone
(607) 844-8181
Fax
(607) 844-4288
NPI assigned
Jan 6, 2006
Last updated
Mar 19, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 005551 NY Primary

Addresses

Primary practice location

5 Evergreen St.
Dryden, NY 13053-0008

Mailing address

PO Box 8
Dryden, NY 13053-0008
Phone (607) 844-8181

Other identifiers 1

IdentifierTypeStateIssuer
02181482MedicaidNY

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rebecca.tillotson@direct.lourdes.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
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
I20091117000219 NY Practitioner - Physician Assistant 5193863801 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

169 Riveride Dr
Binghamton, NY 13905-4246

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
005551NYMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Our Lady of Lourdes Memorial Hospital, Inc. Physician Assistant CurrentSince Jan 2, 2019 Accepting new patients
Our Lady of Lourdes Memorial Hospital, Inc. CurrentSince Jan 2, 2019 Accepting new patients
Twin Tier Pathology Associates, PC Current Accepting new patients
Family Health Network of Central New York, Inc. Physician Assistant Past Accepting new patients
Chenango Memorial Hospital, Inc. Physician Assistant Past Accepting new patients

Locations

161 Riverside Dr
Ste 205
Binghamton, NY 13905
Phone (607) 798-6176

169 Riverside Dr
Binghamton, NY 13905
Phone (607) 798-5111

169 Riverside Dr
Ste 206
Binghamton, NY 13905
Phone (607) 798-6701

Interoperability endpoints

  • Direct secure messaging: rebecca.tillotson@direct.lourdes.com
  • Direct secure messaging: rtillotson196790@direct-guthrie.org

Organizations & group practices 6

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 2

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": "1136505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616112000000",
    "number": "1194703488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8",
            "city": "DRYDEN",
            "state": "NY",
            "postal_code": "130530008",
            "telephone_number": "607-844-8181",
            "fax_number": "607-844-4288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 EVERGREEN ST.",
            "city": "DRYDEN",
            "state": "NY",
            "postal_code": "130530008",
            "telephone_number": "607-844-8181",
            "fax_number": "607-844-4288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLOTSON",
        "first_name": "REBECCA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-06",
        "last_updated": "2021-03-19",
        "certification_date": "2021-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "005551",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02181482",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rebecca.tillotson@direct.lourdes.com",
            "affiliation": "N",
            "endpointDescription": "Lourdes Hospital",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "161 Riverside Dr Ste 205",
            "city": "Binghamton",
            "state": "NY",
            "country_code": "US",
            "postal_code": "139054178",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Dryden, NY

Sources for this page

Verify at the official NPI Registry.