Janice Johnson Tillman, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

904041 Issued in MS

Practice address

5429 Robinson Road Ext
Jackson, MS 39204-4138

Phone

(601) 914-0163

Fax

(601) 914-0170

NPI assigned

Mar 6, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

• Central Mississippi Health Services, Inc

  • Federally Qualified Health Center (FQHC)
  • Jackson, MS
  • NPI 1730120502

  MS

  Medicare reassignment NPD
• Central Mississippi Health Services, Inc

  • Federally Qualified Health Center (FQHC)
  • Jackson, MS
  • NPI 1003470758
  NPD
• Central Mississippi Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Jackson, MS
  • NPI 1356483283
  NPD

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

{
    "created_epoch": "1583452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624233600000",
    "number": "1497380711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2050 RUSSELL J TILLMAN RD",
            "city": "EDWARDS",
            "state": "MS",
            "postal_code": "390669101",
            "telephone_number": "601-988-3728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5429 ROBINSON ROAD EXT",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392044138",
            "telephone_number": "601-914-0163",
            "fax_number": "601-914-0170"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2050 Russell J Tillman Rd",
            "address_purpose": "LOCATION",
            "city": "Edwards",
            "state": "MS",
            "postal_code": "390669101",
            "country_code": "US",
            "telephone_number": "601-988-3728",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TILLMAN",
        "first_name": "JANICE",
        "middle_name": "JOHNSON",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-06",
        "last_updated": "2021-06-21",
        "certification_date": "2021-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MS",
            "license": "884780",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "904041",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittany Leigh Tichenor, MS, LPC
• Christopher Martin Tidwell, MD
• Tier-3 Solutions, Inc.
• Tiffany Daniels
• Emily B Tillman, RD
• Tammie L. Tillman, FNP
• Uneika Tillman, PLPC
• Gregory Timberlake, MD
• Kenneth Tinsley, NURSE PRACTITIONER
• Maria Clarissa Ong Tio, M.D.

• All providers in Jackson, MS
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2021; 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.