Todd L Gilliam
Individual provider Active NPI Family Nurse Practitioner · Rutherfordton, NC
NPI 1326657883 · NPPES record last updated Dec 5, 2020
Key facts
- NPI
- 1326657883
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 5013402 (NC)
- Practice address
- 288 S Ridgecrest Ave
Rutherfordton, NC 28139-2838 - Phone
- (828) 286-5000
- NPI assigned
- Jul 30, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Emergency Coverage LLC
Practice addresses (Care Compare)
288 S Ridgecrest Ave
Rutherfordton, NC 28139-2838
Phone (828) 286-5000
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20201014001584 | NC | Practitioner - Nurse Practitioner | 8224458195 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5013402 | NC | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Emergency Coverage, LLC | Nurse Practitioner | Current |
Accepting new patients |
| Emergency Coverage Services, PC | Nurse Practitioner | Past | Accepting new patients |
Locations
615 Ridge Rd
Roxboro, NC 27573
Phone (336) 503-5699
288 S Ridgecrest Ave
Rutherfordton, NC 28139
Phone (252) 808-6000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 5013402 | NC | Yes |
Addresses
Primary practice location
288 S Ridgecrest Ave
Rutherfordton, NC 28139-2838
Mailing address
1811 Old Caroleen Rd
Forest City, NC 28043-3766
Phone (864) 621-3232
Other providers in Rutherfordton, NC
- Gamewell Audiology, PLLC
- Shaaron Gail Gardner
- Gaston Family Health Services Inc
- Gaston Family Health Services, Inc
- Genesis Rehab Services
- Jason Phillip Glover
- Abigail F Gonzales
- Shannon Gonzalez
- Wifredo Gonzalez
- Gregory Blake Goode
All providers in Rutherfordton, NC · Family Nurse Practitioner in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 5, 2020. 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.