NPIMap

Organization Active NPI

Tillges Certified Orthotic Prosthetic, Inc.

  • Prosthetic/Orthotic Supplier
  • Maplewood, MN
National Provider Identifier
1568428092
Registry record updated Jul 31, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
Legal business name
TILLGES CERTIFIED ORTHOTIC PROSTHETIC, INC.
Practice address
1570 Beam Ave
Suite 100
Maplewood, MN 55109-1166
Phone
(651) 772-2665
Fax
(651) 771-6553
NPI assigned
Apr 24, 2006
Last updated
Jul 31, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2007

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

Authorized official

Name
Mr. Robert James Tillges, CPO
Title
Owner, President
Phone
(651) 772-2665

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthetic/Orthotic Supplier 335E00000X Primary

Addresses

Primary practice location

1570 Beam Ave
Suite 100
Maplewood, MN 55109-1166

Mailing address

1570 Beam Ave
Suite 100
Maplewood, MN 55109-1166
Phone (651) 772-2665

Other identifiers 7

IdentifierTypeStateIssuer
21446OtherMNHEALTH PARTNERS
8200376OtherMNMEDICA
2G045TIOtherMNBLUECROSS/BLUE SHIELD
1018417OtherMNPREFERRED ONE
102162OtherMNUCARE
41783200OtherWIWISCONSIN MEDICAID
54075OtherNDNORTH DAKOTA MEDICAID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930004554 MN DME Supplier - Orthotic PersonnelDME Supplier - Medical Supply Company With Orthotic PersonnelDME Supplier - Prosthetic PersonnelDME Supplier - Medical Supply Company With Prosthetic Personnel 5496873036 Practice locations: Maplewood, MN

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Tillges Certified Orthotic Prosthet1570 Beam Ave, Maplewood, MN 55109-3136(651) 772-2665 Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf|Limb Prostheses|Diabetic Shoes and Inserts|Diabetic Shoes/Inserts - Custom|Lymphedema Compression Treatment Items Does not accept assignmentParticipating since Jan 1, 2000

National Provider Directory

National Provider Directory
Tax ID family
Tillges Cert Orthpros3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1145836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185840000000",
    "number": "1568428092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1570 BEAM AVE",
            "address_2": "SUITE 100",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551091166",
            "telephone_number": "651-772-2665",
            "fax_number": "651-771-6553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1570 BEAM AVE",
            "address_2": "SUITE 100",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551091166",
            "telephone_number": "651-772-2665",
            "fax_number": "651-771-6553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TILLGES CERTIFIED ORTHOTIC PROSTHETIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-24",
        "last_updated": "2007-07-31",
        "status": "A",
        "authorized_official_last_name": "TILLGES",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "OWNER, PRESIDENT",
        "authorized_official_telephone_number": "651-772-2665",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPO"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "21446",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "8200376",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS/BLUE SHIELD",
            "identifier": "2G045TI",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "1018417",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "102162",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WISCONSIN MEDICAID",
            "identifier": "41783200",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NORTH DAKOTA MEDICAID",
            "identifier": "54075",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Maplewood, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.