Georgia Liles Tunstill, M.D.
Individual provider Active NPI Anatomic Pathology & Clinical Pathology Physician · Rancho Dominguez, CA
NPI 1295963627 · NPPES record last updated Jan 28, 2016
Key facts
- NPI
- 1295963627
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician 207ZP0102X
- License
- 003643 (GA)
- Practice address
- 2374 E Pacifica PL
Rancho Dominguez, CA 90220-6214 - Phone
- (310) 225-3244
- Fax
- (310) 698-7054
- NPI assigned
- Jun 24, 2009
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 7
Medicare Care Compare profile
- Specialty
- Pathology
- Education
- Loma Linda University School of Medicine, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Central Oregon Pathology Consultants PC
Practice addresses (Care Compare)
1348 NE Cushing Dr
Bend, OR 97701-3876
Hospital & facility affiliations
- St Charles Medical Center - Bend
- Harney District Hospital
- St Charles Madras
- Lake District Hospital
- Ohsu Hospital and Clinics
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230919003276 | OR | Practitioner - Pathology | 1557650629 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A122668 | CA | MD | Anatomic Pathology & Clinical Pathology Physician |
| 003643 | GA | MD | Anatomic Pathology & Clinical Pathology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Central Oregon Pathology Consultants, PC | Anatomic Pathology & Clinical Pathology | Current |
Accepting new patients |
| St. Vincent Anesthesia Medical Group, Inc. | Past | Accepting new patients |
Locations
1348 NE Cushing Dr
Ste 200
Bend, OR 97701
Phone (541) 382-7696
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 003643 | GA | Yes |
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | A122668 | CA |
Addresses
Primary practice location
2374 E Pacifica PL
Rancho Dominguez, CA 90220-6214
Mailing address
2374 E Pacifica PL
Rancho Dominguez, CA 90220-6214
Phone (310) 225-3244
Other names
- Georgia B Liles
Other providers in Rancho Dominguez, CA
- Daniel Real
- Michael Schkloven
- Shezfit
- Soc Pathology Medical Group Inc.
- Adam Stelling
- Uniscoat Inc.
- Miriam A Velazquez
- Jeffrey Bob Virgin
- Yong Wung Yoo
All providers in Rancho Dominguez, CA · Anatomic Pathology & Clinical Pathology Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 28, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.