NPIMap

Individual provider Active NPI

Lori M Tilden-Smith, PA

  • Physician Assistant
  • Enfield, CT
National Provider Identifier
1386636223
Registry record updated Dec 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1160 Issued in MA
Practice address
100 Hazard Ave Ste 101
Enfield, CT 06082-5447
Phone
(860) 696-2380
NPI assigned
Aug 17, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 968 CT
Physician Assistant 363A00000X 1160 MA Primary

Addresses

Primary practice location

100 Hazard Ave Ste 101
Enfield, CT 06082-5447

Mailing address

100 Hazard Ave Ste 101
Enfield, CT 06082-5447
Phone (860) 696-2380

Other practice location 1

300 Birnie Ave
Suite 102
Springfield, MA 01107-1107
Phone (413) 734-4206

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, CT2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180605000238 MA Practitioner - Physician Assistant 4082986864 Reassigns benefits to 1 organization
I20231113000630 CT Practitioner - Physician Assistant 4082986864 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Hartford Healthcare Medical Group IncGroup PAC ID 1153573902, 257 clinicians

Practice addresses (Care Compare)

55 Meriden Ave
Suite 1D
Southington, CT 06489-3239
Phone (860) 276-5144

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1160MAMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Hartford Healthcare Medical Group, Inc Physician Assistant CurrentSince Jan 1, 2024 Accepting new patients
Hartford Healthcare Medical Group, Inc Past Accepting new patients

Locations

100 Hazard Ave
Ste 101
Enfield, CT 06082
Phone (860) 696-2240

55 Meriden Ave
Ste 1D
Southington, CT 06489
Phone (860) 276-5144

1290 Silas Deane Hwy
Wethersfield, CT 06109
Phone (860) 972-6977

Interoperability endpoints

  • Direct secure messaging: lori.tilden-smith@xdr.hhchealthdirect.org

Organizations & group practices 3

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 9

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": "1124236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703894400000",
    "number": "1386636223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 HAZARD AVE STE 101",
            "city": "ENFIELD",
            "state": "CT",
            "postal_code": "060825447",
            "telephone_number": "860-696-2380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 HAZARD AVE STE 101",
            "city": "ENFIELD",
            "state": "CT",
            "postal_code": "060825447",
            "telephone_number": "860-696-2380"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 Birnie Ave",
            "address_2": "Suite 102",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "MA",
            "postal_code": "011071107",
            "country_code": "US",
            "telephone_number": "413-734-4206",
            "fax_number": "413-737-8882",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TILDEN-SMITH",
        "first_name": "LORI",
        "middle_name": "M",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-17",
        "last_updated": "2023-12-30",
        "certification_date": "2023-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CT",
            "license": "968",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MA",
            "license": "1160",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Enfield, CT

Sources for this page

Verify at the official NPI Registry.