Sara E. Tisdale, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

45990 Issued in CO

Practice address

6001 E Woodmen Rd
RM 5242
Colorado Springs, CO 80923-2601

Phone

(719) 571-5242

Fax

(719) 571-5248

NPI assigned

May 15, 2007

Last updated

Dec 19, 2008By the provider in NPPES

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 CO

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/1928/brand/1/csg/62/fhir/r4

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.

• Peak Vista Community Health Centers

  • Federally Qualified Health Center (FQHC)
  • Colorado Springs, CO
  • NPI 1730166034
  Medicare reassignment NPD
• Colorado Plains Physician Practices LLC

  • Cardiovascular Disease Physician
  • Fort Morgan, CO
  • NPI 1821042409
  NPD
• Peak Vista Community Health Centers

  dba Behavioral Health at Inside Out Youth Services

  • Federally Qualified Health Center (FQHC)
  • Colorado Springs, CO
  • NPI 1871347443
  NPD
• Mountain View Medical Group, PC

  dba The Walking Clinic

  • Durable Medical Equipment & Medical Supplies
  • Colorado Springs, CO
  • NPI 1144405200
  NPD (past)
• Mountain View Medical Group, PC

  • Family Medicine Physician
  • Colorado Springs, CO
  • NPI 1295787703

  Pediatrics

  NPD (past)
• Thompson River Pediatrics and Urgent Care, LLC

  • Pediatrics Physician
  • Johnstown, CO
  • NPI 1497155089
  NPD (past)

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

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1229644800000",
    "number": "1467668798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6001 E WOODMEN RD",
            "address_2": "RM 5242",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809232601",
            "telephone_number": "719-571-5242",
            "fax_number": "719-571-5248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6001 E WOODMEN RD",
            "address_2": "RM 5242",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809232601",
            "telephone_number": "719-571-5242",
            "fax_number": "719-571-5248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TISDALE",
        "first_name": "SARA",
        "middle_name": "E.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-15",
        "last_updated": "2008-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CO",
            "license": "45990",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "99753570",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Matthew Tippets
• Mariah Tipton
• Haley Rebekah Tirado
• Teresita Marie Tirona, MA, LPC
• Kristina Tischmak, RN, BSN
• Barbara Candus Tise, LPC NCC
• Jayme R Tishon, MD
• Shannon Grace Tisson, PA-C
• Jessica Titone, LPCC
• Betsy Titus, PTA

• Pediatrics Physician in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Pediatrics Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2008; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.