Kim Tillemans, DO

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

47806 Issued in MN

Practice address

1020 West Broadway
Ump Broadway Family Medicine Urgent Care
Minneapolis, MN 55411

Phone

(612) 302-8275

NPI assigned

Oct 11, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Other, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Fairview ClinicsGroup PAC ID 7113830142, 799 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• M Health Fairview Ridges Hospital Hospital, Burnsville, MN, CCN 240207

Merit-based Incentive Payment System (MIPS)

Final score

92.35 of 100Reported as group

Quality

91.74

Promoting interoperability

100

Improvement activities

40

Cost

77.13

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ktillemans113054@fairview.direct-ci.com

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.

• Fairview Clinics

  • Primary Care Clinic/Center
  • Minneapolis, MN
  • NPI 1346432218
  Medicare reassignment Care Compare group NPD
• Fairview Clinics

  • Primary Care Clinic/Center
  • Saint Paul, MN
  • NPI 1396552147
  NPD
• Fairview Clinics

  • Primary Care Clinic/Center
  • Apple Valley, MN
  • NPI 1649462508
  NPD
• Fairview Clinics

  • Multi-Specialty Clinic/Center
  • Maple Grove, MN
  • NPI 1841315165
  NPD (past)
• Fairview Health Services

  • General Acute Care Hospital
  • Burnsville, MN
  • NPI 1245217520
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Fairview Health Services

  • General Acute Care Hospital
  • Burnsville, MN
  • NPI 1225199128
  Care Compare affiliation
• Fairview Health Services

  • General Acute Care Hospital
  • Burnsville, MN
  • NPI 1245217520
  Care Compare affiliation

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

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717372800000",
    "number": "1306935317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 DELAWARE STREET SE",
            "address_2": "UNIVERSITY OF MINNESOTA PHYSICIANS",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55455",
            "telephone_number": "612-302-8275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 WEST BROADWAY",
            "address_2": "UMP BROADWAY FAMILY MEDICINE URGENT CARE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55411",
            "telephone_number": "612-302-8275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLEMANS",
        "first_name": "KIM",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-11",
        "last_updated": "2024-06-03",
        "certification_date": "2024-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "47806",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MN",
            "license": "47806",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0596106",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43523000",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPARTNERS",
            "identifier": "HP54459",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "66-08643",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mustafa A Tiewala, M.D.
• Efrah Tifow
• Najma Abdi Tifow
• Christopher James Tignanelli, MD
• Jacob Laurence Tigner, MD
• Tillges Certified Orthotic Prosthetic, Inc.
• Nicole Marie Tillman
• Julie Tilsen, M.A., LP
• Jessica Carny Tilton, RD
• Joshua Timberlake

• Obstetrics & Gynecology Physician in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Obstetrics & Gynecology Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.