NPIMap

Individual provider Active NPI

David J Tilstra, MD

  • Clinical Genetics (M.D.) Physician
  • Saint Cloud, MN
National Provider Identifier
1316928351
Registry record updated Dec 13, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Genetics (M.D.) PhysicianTaxonomy code 207SG0201X
License
37920 Issued in MN
Practice address
1900 Centracare Cir
Saint Cloud, MN 56303-5000
Phone
(320) 654-3630
Fax
(320) 654-3657
NPI assigned
Nov 8, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Genetics (M.D.) Physician 207SG0201X 37920 MN Primary
Pediatrics Physician 208000000X 37920 MN

Addresses

Primary practice location

1900 Centracare Cir
Saint Cloud, MN 56303-5000

Mailing address

1900 Centracare Cir
Saint Cloud, MN 56303-5000
Phone (320) 654-3630

Other identifiers 9

IdentifierTypeStateIssuer
1008055OtherPREFERRED ONE
763003OtherARAZ GROUP AMERICAS PPO
51A44TIOtherBLUE CROSS BLUE SHIELD
1200086OtherMEDICA HEALTH PLANS
2089340OtherFIRST HEALTH PLAN
7713350OtherSOUTH DAKOTA MA
HP25528OtherHEALTH PARTNERS
074814500OtherMEDICAL ASSISTANCE
110417OtherUCARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
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
I20100302000134 MN Practitioner - Pediatric Medicine 3971686452 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
University of Iowa, RJ & L Carver College of Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St Cloud HospitalGroup PAC ID 4880594779, 215 clinicians
Centracare ClinicGroup PAC ID 2466363395, 800 clinicians

Practice addresses (Care Compare)

110 2ND St S
Suite 104
Waite Park, MN 56387-1367
Phone (320) 259-9375

1200 6TH Ave N
Saint Cloud, MN 56303-2735

1200 6TH N Ave
Saint Cloud, MN 56303-2735
Phone (320) 252-5131

1900 Centracare Cir
Saint Cloud, MN 56303-5000

301 Becker Ave SW
Rice Memorial Hosptial
Willmar, MN 56201-3302
Phone (320) 235-4543

PO Box
Chicago, IL 60673

Hospital & facility affiliations

  • Centracare - St. Cloud Hospital Hospital, Saint Cloud, MN, CCN 240036
  • Centracare- Rice Memorial Hospital Hospital, Willmar, MN, CCN 240088

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
37920MNMDClinical Genetics (M.D.) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Centracare Clinic Current Accepting new patients
St. Cloud Hospital CurrentSince Sep 5, 2018 Accepting new patients
Centracare Clinic CurrentSince Jun 1, 1997 Accepting new patients
Centracare Clinic CurrentSince Jun 1, 1997 Accepting new patients
Centracare Clinic Past Accepting new patients
St. Cloud Hospital Past Accepting new patients

Locations

1406 6th Ave N
Saint Cloud, MN 56303
Phone (320) 255-5657

1900 Centracare Cir
Saint Cloud, MN 56303
Phone (320) 252-2422

1200 6th Ave N
Saint Cloud, MN 56303
Phone (320) 252-3342

110 2nd St S
Ste 104
Waite Park, MN 56387
Phone (320) 259-9375

Interoperability endpoints

  • Direct secure messaging: dtilstra1618@direct.centracare.com

Organizations & group practices 7

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.

Hospital & facility affiliations 8

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": "1131408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323734400000",
    "number": "1316928351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 CENTRACARE CIR",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563035000",
            "telephone_number": "320-654-3630",
            "fax_number": "320-654-3657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 CENTRACARE CIR",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563035000",
            "telephone_number": "320-654-3630",
            "fax_number": "320-654-3657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILSTRA",
        "first_name": "DAVID",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-08",
        "last_updated": "2011-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207SG0201X",
            "taxonomy_group": "",
            "desc": "Medical Genetics, Clinical Genetics (M.D.)",
            "state": "MN",
            "license": "37920",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "37920",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "1008055",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARAZ GROUP AMERICAS PPO",
            "identifier": "763003",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "51A44TI",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA HEALTH PLANS",
            "identifier": "1200086",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST HEALTH PLAN",
            "identifier": "2089340",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOUTH DAKOTA MA",
            "identifier": "7713350",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "HP25528",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL ASSISTANCE",
            "identifier": "074814500",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "110417",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, MN

Sources for this page

Verify at the official NPI Registry.