NPIMap

Individual provider Active NPI

Barry Forrest Tillman, M.D.

  • Pulmonary Disease Physician
  • Vidalia, LA
National Provider Identifier
1457349110
Registry record updated Jan 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
License
07480R Issued in LA
Practice address
107 Front St
Vidalia, LA 71373-2836
Phone
(318) 336-2216
Fax
(318) 336-6075
NPI assigned
Oct 7, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X 07480R LA Primary
Pulmonary Disease Physician 207RP1001X 11444 MS

Addresses

Primary practice location

107 Front St
Vidalia, LA 71373-2836

Mailing address

107 Front St
Vidalia, LA 71373-2836
Phone (318) 336-2216

Other identifiers 2

IdentifierTypeStateIssuer
1371483MedicaidLA
0115584MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
07480RLAMDPulmonary Disease Physician
11444MSMDPulmonary Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tillman Medical Group PA Current Accepting new patients
Professional Rehabilitation Hospital LLC Past Accepting new patients
Natchez Anesthesia Past Accepting new patients
Sayer & Soileau Anesthesia, LLC Past Accepting new patients

Locations

107 Front St
Vidalia, LA 71373
Phone (318) 336-2216

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1128643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484092800000",
    "number": "1457349110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 FRONT ST",
            "city": "VIDALIA",
            "state": "LA",
            "postal_code": "713732836",
            "telephone_number": "318-336-2216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 FRONT ST",
            "city": "VIDALIA",
            "state": "LA",
            "postal_code": "713732836",
            "telephone_number": "318-336-2216",
            "fax_number": "318-336-6075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLMAN",
        "first_name": "BARRY",
        "middle_name": "FORREST",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-07",
        "last_updated": "2017-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "LA",
            "license": "07480R",
            "primary": true
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "MS",
            "license": "11444",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1371483",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0115584",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vidalia, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.