Active NPI
Richard Tilley, M.D.
- Internal Medicine Physician
- Gulfport, MS
National Provider Identifier
1275648099
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 07061
- Practice address
- 1110 Broad Ave
Suite 700
Gulfport, MS 39501-8907 - Phone
- (228) 864-0314
- Fax
- (228) 864-0425
- NPI assigned
- Aug 20, 2006
- Last updated
- Sep 29, 2026
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 07061 | MS | Primary |
Addresses
Primary practice location
1110 Broad Ave
Suite 700
Gulfport, MS 39501-8907
Mailing address
PO Box 555
Biloxi, MS 39533-0555
Phone (228) 864-8454
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110105095 | Other | MS | RAILROAD MEDICARE |
| 00112524 | Medicaid | MS |
Other names 1
- Dr. Richard Tilley
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 07061 | MS | MD | Internal Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Stone County Hospital, Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156032000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1790640000000",
"number": "1275648099",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 555",
"city": "BILOXI",
"state": "MS",
"postal_code": "395330555",
"telephone_number": "228-864-8454",
"fax_number": "228-865-1457"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1110 BROAD AVE",
"address_2": "SUITE 700",
"city": "GULFPORT",
"state": "MS",
"postal_code": "395018907",
"telephone_number": "228-864-0314",
"fax_number": "228-864-0425"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TILLEY",
"first_name": "RICHARD",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-20",
"last_updated": "2026-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MS",
"license": "07061",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "110105095",
"state": "MS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00112524",
"state": "MS"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "RICHARD",
"last_name": "TILLEY",
"prefix": "DR.",
"credential": "M.D.",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Gulfport, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.