Brian Tillis, MD

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

69543-20 Issued in WI

Practice address

9555 76TH St Ste 4105
Pleasant Prairie, WI 53158-1984

Phone

(262) 577-8080

Fax

(262) 577-8081

NPI assigned

Mar 28, 2016

Sex

Male

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 WI

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

Specialty

Obstetrics/Gynecology

Education

Southern Illinois University School of Medicine, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Froedtert South IncGroup PAC ID 9537071196, 158 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Froedtert South Inc. Hospital, Kenosha, WI, CCN 520021

Merit-based Incentive Payment System (MIPS)

Final score

83.15 of 100Reported as group

Quality

69.39

Promoting interoperability

100

Improvement activities

40

Cost

74.44

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: btillismd199369@direct.froedtert.com

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.

• Froedtert South, Inc.

  • Family Medicine Physician
  • Kenosha, WI
  • NPI 1558305284
  Medicare reassignment Care Compare group NPD
• Froedtert South, Inc.

  • General Acute Care Hospital
  • Pleasant Prairie, WI
  • NPI 1003831132
  NPD (past)

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

• Froedtert South, Inc.

  • General Acute Care Hospital
  • Pleasant Prairie, WI
  • NPI 1003831132
  Care Compare affiliation

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

{
    "created_epoch": "1459123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594857600000",
    "number": "1396107405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9555 76TH ST # 4105",
            "city": "PLEASANT PRAIRIE",
            "state": "WI",
            "postal_code": "531581984",
            "telephone_number": "262-577-8080",
            "fax_number": "262-577-8081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9555 76TH ST STE 4105",
            "city": "PLEASANT PRAIRIE",
            "state": "WI",
            "postal_code": "531581984",
            "telephone_number": "262-577-8080",
            "fax_number": "262-577-8081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLIS",
        "first_name": "BRIAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-03-28",
        "last_updated": "2020-07-16",
        "certification_date": "2020-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "WI",
            "license": "69543-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WI LICENSE",
            "identifier": "69543-20",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Xiaoming Sun, M.D.
• Brenna Sunderland-Saied, RD, CD
• Cindi Svoboda, COTA
• Nicole Taylor
• Brianna Diane Thomas
• Lauren D Toner, PT, DPT
• Eduardo Andres Torre Valdivieso, MD
• Anne Colleen Totero, LMFT
• Joyce E Turley, M.D.
• Amanda Umnus, APNP

• Obstetrics & Gynecology Physician in Pleasant Prairie, WI
• Providers in Pleasant Prairie, WI by specialty
• Obstetrics & Gynecology Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2020; 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.