Evan Tilley, MD

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

021012 Issued in CT

Practice address

267 Grant St
Bridgeport Anesthesia Associates, PC
Bridgeport, CT 06610-2805

Phone

(203) 384-3072

NPI assigned

Jan 18, 2007

Last updated

Oct 27, 2009By the provider in NPPES

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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1256601600000",
    "number": "1194878868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7365 MAIN ST",
            "address_2": "STE 310",
            "city": "STRATFORD",
            "state": "CT",
            "postal_code": "066141300",
            "telephone_number": "203-384-3174"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "267 GRANT ST",
            "address_2": "BRIDGEPORT ANESTHESIA ASSOCIATES, PC",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066102805",
            "telephone_number": "203-384-3072"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLEY",
        "first_name": "EVAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-18",
        "last_updated": "2009-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CT",
            "license": "021012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001210129",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA CT",
            "identifier": "0187258",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Anesthesiology Physician in Bridgeport, CT
• Providers in Bridgeport, CT by specialty
• Anesthesiology Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.