NPIMap

Individual provider Active NPI

Tambrea Toylett Ellison, M.D.

  • Physical Medicine & Rehabilitation Physician
  • Stockbridge, GA
National Provider Identifier
1306005202
Registry record updated Dec 7, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
69187 Issued in GA
Practice address
900 Eagles Landing Pkwy
Stockbridge, GA 30281-7343
Phone
(770) 997-0600
NPI assigned
Jun 5, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2016

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X LL30874 SC
Interventional Pain Medicine Physician 208VP0014X 69187 GA
Pain Medicine Physician 208VP0000X 69187 GA
Physical Medicine & Rehabilitation Physician 208100000X 69187 GA Primary
Pain Medicine (Physical Medicine & Rehabilitation) Physician 2081P2900X 69187 GA

Addresses

Primary practice location

900 Eagles Landing Pkwy
Stockbridge, GA 30281-7343

Mailing address

1185 Collier Rd NW
Apt 1329
Atlanta, GA 30318-8232
Phone (706) 210-8027

Other identifiers 6

IdentifierTypeStateIssuer
003137503BMedicaidGA
003137503FMedicaidGA
003137503DMedicaidGA
003137503AMedicaidGA
003137503CMedicaidGA
003137503EMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20130624000446 GA Practitioner - Pain ManagementPractitioner - Physical Medicine and Rehabilitation 6507016243 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pain ManagementAlso: Physical Medicine and Rehabilitation
Education
Medical College of Georgia School of Medicine, 2008
Medicare assignment
May accept Medicare assignment
Group practices
South Georgia Medical Center IncGroup PAC ID 1052764677, 58 clinicians
Care Medical Center LLCGroup PAC ID 6406807015, 28 clinicians

Practice addresses (Care Compare)

2501 N Patterson St
Valdosta, GA 31602-1735
Phone (229) 259-4291

2804 N Oak St
Suite C
Valdosta, GA 31602-5913
Phone (229) 241-8925

Hospital & facility affiliations

  • SGMC Health Hospital, Valdosta, GA, CCN 110122
  • Southwell Medical, a Campus of TRMC Hospital, Adel, GA, CCN 110101
  • South Georgia Medical Center Inpatient rehabilitation facility, Valdosta, GA, CCN 11T122

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
LL30874SCMDInternal Medicine Physician
69187GAMDPain Medicine (Physical Medicine & Rehabilitation) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Care Medical Center LLC CurrentSince Jan 3, 2022 Accepting new patients
Care Medical Center LLC Physical Medicine & Rehabilitation CurrentSince Jan 3, 2022 Accepting new patients
Hospital Authority of Valdosta and Lowndes County Georgia CurrentSince Apr 1, 2022 Accepting new patients
South Georgia Medical Center Inc Interventional Pain Medicine CurrentSince Jun 1, 2024 Accepting new patients
South Georgia Medical Center Inc CurrentSince Jun 1, 2024 Accepting new patients
Hospital Authority of Valdosta and Lowndes County Georgia Interventional Pain Medicine Current Accepting new patients
Hospital Authority of Valdosta and Lowndes County, Georgia CurrentSince Apr 1, 2022 Accepting new patients
Hospital Authority of Valdosta and Lowndes County Georgia Interventional Pain Medicine Past Accepting new patients
Georgia Pain Physicians PC Pain Medicine Past Accepting new patients

Locations

306 Shirley Ave
Douglas, GA 31533
Phone (229) 241-8925

162 Virginia Ave S
Tifton, GA 31794
Phone (229) 241-8925

2501 N Patterson St
Valdosta, GA 31602
Phone (229) 259-4139

2804 N Oak St
Ste C
Valdosta, GA 31602
Phone (229) 241-8925

1411 Alice St
Waycross, GA 31501
Phone (912) 282-2989

Interoperability endpoints

  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations & group practices 18

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 18

Hospital & facility affiliations 3

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": "1212624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481068800000",
    "number": "1306005202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1185 COLLIER RD NW",
            "address_2": "APT 1329",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303188232",
            "telephone_number": "706-210-8027"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 EAGLES LANDING PKWY",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302817343",
            "telephone_number": "770-997-0600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLISON",
        "first_name": "TAMBREA",
        "middle_name": "TOYLETT",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-05",
        "last_updated": "2016-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "SC",
            "license": "LL30874",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "GA",
            "license": "69187",
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "GA",
            "license": "69187",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "GA",
            "license": "69187",
            "primary": true
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "GA",
            "license": "69187",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003137503B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003137503F",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003137503D",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003137503A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003137503C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003137503E",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stockbridge, GA

Sources for this page

Verify at the official NPI Registry.