Individual provider Active NPI

John Burton Tiffany, M.D.

  • Pediatrics Physician
  • Aiken, SC
National Provider Identifier
1386616084
Registry record updated Oct 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
18765 Issued in SC
Practice address
215 Town Creek Rd
Aiken, SC 29803-5843
Phone
(803) 508-7651
Fax
(803) 508-7655
NPI assigned
Feb 6, 2006
Last updated
Oct 6, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 18765 SC Primary

Addresses

Primary practice location

215 Town Creek Rd
Aiken, SC 29803-5843

Mailing address

215 Town Creek Rd
Aiken, SC 29803-5843
Phone (803) 508-7651

Other identifiers 1

IdentifierTypeStateIssuer
187657MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
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

Enrollment IDStateProvider typePAC IDDetails
I20180320000002 SC Practitioner - Pediatric Medicine 1951459692 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Liberty Doctors, LLC CurrentSince Jan 10, 2018 Accepting new patients
Liberty Doctors LLC Pediatrics CurrentSince Jan 10, 2018 Accepting new patients
Liberty Doctors LLC Past Accepting new patients
Hitchcock Healthcare, Incorporated PastSince Apr 28, 2009 Accepting new patients
Liberty Doctors, LLC Pediatrics Past Accepting new patients

Locations

215 Town Creek Rd
Aiken, SC 29803
Phone (803) 508-7651

418 Folly Rd
#A
Charleston, SC 29412
Phone (843) 225-8320

Interoperability endpoints

  • Direct secure messaging: jtiffany@libertydoctors.ssdirect.aprima.com
  • Direct secure messaging: jtiffany@tiffanypeds.gwaydirect.com

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1139184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1507248000000",
    "number": "1386616084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 TOWN CREEK RD",
            "city": "AIKEN",
            "state": "SC",
            "postal_code": "298035843",
            "telephone_number": "803-508-7651",
            "fax_number": "803-508-7655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 TOWN CREEK RD",
            "city": "AIKEN",
            "state": "SC",
            "postal_code": "298035843",
            "telephone_number": "803-508-7651",
            "fax_number": "803-508-7655"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIFFANY",
        "first_name": "JOHN",
        "middle_name": "BURTON",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-06",
        "last_updated": "2017-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "SC",
            "license": "18765",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "187657",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Aiken, SC

Sources for this page

Verify at the official NPI Registry.