Active NPI
John W Tilley Jr., MD
- Internal Medicine Physician
- Bellingham, WA
National Provider Identifier
1568519486
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- MD00030045
- Practice address
- 220 Unity St
Bellingham, WA 98225-4420 - Phone
- (360) 676-6177
- Fax
- (360) 671-3574
- NPI assigned
- Jan 4, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MD00030045 | WA | Primary |
Addresses
Primary practice location
220 Unity St
Bellingham, WA 98225-4420
Mailing address
1616 Cornwall Ave Ste 205
Bellingham, WA 98225-4642
Phone (360) 676-6177
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8161119 | Medicaid | WA | |
| 199778 | Other | WA | L & I NUMBER |
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
| License | State | Type | Specialty |
|---|---|---|---|
| MD00030045 | WA | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167868800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1627516800000",
"number": "1568519486",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1616 CORNWALL AVE STE 205",
"city": "BELLINGHAM",
"state": "WA",
"postal_code": "982254642",
"telephone_number": "360-676-6177",
"fax_number": "360-671-3574"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "220 UNITY ST",
"city": "BELLINGHAM",
"state": "WA",
"postal_code": "982254420",
"telephone_number": "360-676-6177",
"fax_number": "360-671-3574"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TILLEY",
"first_name": "JOHN",
"middle_name": "W",
"name_suffix": "Jr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-04",
"last_updated": "2021-07-29",
"certification_date": "2021-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "WA",
"license": "MD00030045",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8161119",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "L & I NUMBER",
"identifier": "199778",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Bellingham, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.