Tiffanny M Connolly, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

385002364 Issued in IL

Practice address

427 W Northmoor Rd
Peoria, IL 61614-3542

Phone

(309) 692-5337

Fax

(309) 693-3913

NPI assigned

Jun 10, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Midwestern University, Chicago College of Osteopathic Med, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The Bleeding and Clotting Disorders InstituteGroup PAC ID 6608051230, 10 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Saint Francis Medical Center Hospital, Peoria, IL, CCN 140067
• Carle Health Methodist Hospital Hospital, Peoria, IL, CCN 140209

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tiffanny.connolly@4214.securemail.prognocis.com

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.

• The Bleeding and Clotting Disorders Institute

  • Clinic/Center
  • Peoria, IL
  • NPI 1134424633
  Medicare reassignment Care Compare group
• Michael D. Tarantino, M.D. S.C.

  • Pediatric Hematology & Oncology Physician
  • Peoria, IL
  • NPI 1740430784
  Medicare reassignment
• The Bleeding and Clotting Disorders Institute

  • Pediatric Hematology & Oncology Physician
  • Peoria, IL
  • NPI 1528925666
  NPD
• Fastrac Medical, P.C.

  • Emergency Medicine Physician
  • Joliet, IL
  • NPI 1659517597
  NPD (past)

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

• Methodist Medical Center of Illinois

  • General Acute Care Hospital
  • Peoria, IL
  • NPI 1164474755
  Care Compare affiliation

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

{
    "created_epoch": "1276128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634774400000",
    "number": "1346560497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "427 W NORTHMOOR RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616143542",
            "telephone_number": "309-692-5337",
            "fax_number": "309-693-3913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "427 W NORTHMOOR RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616143542",
            "telephone_number": "309-692-5337",
            "fax_number": "309-693-3913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNOLLY",
        "first_name": "TIFFANNY",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-10",
        "last_updated": "2021-10-21",
        "certification_date": "2021-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "385002364",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "F400773279",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Darren Conklin, DO
• D'Arcy Marie Conley, LCPC
• Susan Conley
• Dorothy L Conlon, LPC
• Karen Rose Conlon
• Anistyn Connor
• Kathryn Smith Connor
• Anthony J Conway
• Clara Patricia Conway, PTA
• Abbey Cook, MS, CCC-SLP

• Physician Assistant in Peoria, IL
• Providers in Peoria, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2021; 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.