Jay Tillman, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

038679 Issued in CT

Practice address

50 Albany Turnpike
Canton Gateway Office Park #16
Canton, CT 06019

Phone

(860) 693-8037

Fax

(860) 693-8039

NPI assigned

Jul 19, 2006

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 NJ

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

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.

• Connecticut Maxillofacial Surgeons, LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Farmington, CT
  • NPI 1285651133
  NPD (past)

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1497774384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 FIELDING WOODS",
            "city": "WEST GRANBY",
            "state": "CT",
            "postal_code": "06090",
            "telephone_number": "860-693-8037",
            "fax_number": "860-693-8039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 ALBANY TURNPIKE",
            "address_2": "CANTON GATEWAY OFFICE PARK #16",
            "city": "CANTON",
            "state": "CT",
            "postal_code": "06019",
            "telephone_number": "860-693-8037",
            "fax_number": "860-693-8039"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLMAN",
        "first_name": "JAY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "CT",
            "license": "038679",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "01003867979CT02",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Allyson Szoka, PHARMD
• Janell Tartaglia, DPT, PCS
• Telerad of CT Account Management LLC
• Tete-a-Tete in Groups PLLC
• Jennifer Thompson, PH.D, LPC
• Diane Mary Tobin, MA,NCC,LPC
• Kimberly Lynn Tormay, OTR/L
• Tracy Eckert LLC
• Triple Gem Counseling LLC
• Valley Medical Group

• Psychiatry Physician in Canton, CT
• Providers in Canton, CT by specialty
• Psychiatry Physician in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.