NPIMap

Individual provider Active NPI

Georgia Liles Tunstill, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Rancho Dominguez, CA
National Provider Identifier
1295963627
Registry record updated Jan 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
003643 Issued in 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
Last updated
Jan 28, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 003643 GA Primary
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 1

  • Georgia B Liles Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20230919003276 OR Practitioner - Pathology 1557650629 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
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 PCGroup PAC ID 2860488236, 6 clinicians

Practice addresses (Care Compare)

1348 NE Cushing Dr
Bend, OR 97701-3876

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A122668CAMDAnatomic Pathology & Clinical Pathology Physician
003643GAMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central Oregon Pathology Consultants, PC Anatomic Pathology & Clinical Pathology CurrentSince Sep 11, 2023 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

Organizations & group practices 2

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 7

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": "1245801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1453939200000",
    "number": "1295963627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2374 E PACIFICA PL",
            "city": "RANCHO DOMINGUEZ",
            "state": "CA",
            "postal_code": "902206214",
            "telephone_number": "310-225-3244",
            "fax_number": "310-698-7054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2374 E PACIFICA PL",
            "city": "RANCHO DOMINGUEZ",
            "state": "CA",
            "postal_code": "902206214",
            "telephone_number": "310-225-3244",
            "fax_number": "310-698-7054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUNSTILL",
        "first_name": "GEORGIA",
        "middle_name": "LILES",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-24",
        "last_updated": "2016-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "GA",
            "license": "003643",
            "primary": true
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "CA",
            "license": "A122668",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GEORGIA",
            "last_name": "LILES",
            "middle_name": "B",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Rancho Dominguez, CA

Sources for this page

Verify at the official NPI Registry.