NPIMap

Individual provider Active NPI

Kelli Marie Baker Tillman, FNP-C

  • Nurse Practitioner
  • Sanford, NC
National Provider Identifier
1578112959
Registry record updated Jan 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
F06191243 Issued in NC
Practice address
1411 Greenway CT
Sanford, NC 27330-6954
Phone
(919) 292-1878
NPI assigned
Sep 8, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X F06191243 NC Primary

Addresses

Primary practice location

1411 Greenway CT
Sanford, NC 27330-6954

Mailing address

1197 S Plank Rd
Sanford, NC 27330-8620
Phone (919) 356-2735

Other practice location 1

1197 S Plank Rd
Sanford, NC 27330-8620
Phone (919) 356-2735

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200113000251 NC Practitioner - Nurse Practitioner 9537594007 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
FHPG LLCGroup PAC ID 9537481569, 195 clinicians

Practice addresses (Care Compare)

3110 S Horner Blvd
Sanford, NC 27332-8212
Phone (919) 842-3570

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.84 of 100Reported as group
Quality
79.14
Promoting interoperability
92
Improvement activities
40
Cost
80.32

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F06191243NCMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
MCPC-8, LLC CurrentSince Nov 1, 2022 Accepting new patients
FHPG, LLC CurrentSince Apr 1, 2023 Accepting new patients
FHPG, LLC Current Accepting new patients
MCPC-8, LLC Current Accepting new patients
Pinehurst Medical Clinic, Inc. CurrentSince Dec 16, 2019 Accepting new patients
FHPG, LLC CurrentSince Apr 1, 2023 Accepting new patients
Pinehurst Medical Clinic, Inc. CurrentSince Dec 16, 2019 Accepting new patients
MCPC-8, LLC CurrentSince Nov 1, 2022 Accepting new patients
Pinehurst Medical Clinic, Inc. Past Accepting new patients
FHPG, LLC Past Accepting new patients
MCPC-8, LLC Past Accepting new patients

Locations

208 W Salisbury St
Ste A
Asheboro, NC 27203
Phone (336) 523-0040

225 Capital Dr
Ste 101
Carthage, NC 28327
Phone (910) 215-5100

3716 Morganton Rd
Ste 2
Fayetteville, NC 28303
Phone (910) 215-5100

1021 W Hamlet Ave
Hamlet, NC 28345
Phone (910) 417-4100

205 Page Rd
Pinehurst, NC 28374
Phone (910) 295-9211

150 Ivey Ln
Ste A
Pinehurst, NC 28374
Phone (910) 215-5200

4565 Fayetteville Rd
Raeford, NC 28376
Phone (910) 878-5100

103 Marketplace Dr
Ste 102
Sanford, NC 27332
Phone (919) 897-2250

1602 Westover Dr
Sanford, NC 27330
Phone (919) 897-2250

3110 S Horner Blvd
Sanford, NC 27332
Phone (910) 295-4400

1411 Greenway Ct
Sanford, NC 27330
Phone (919) 292-1878

1690 US Highway 1 S
Ste 100
Southern Pines, NC 28387
Phone (910) 684-2055

7473 NC 22 Hwy
Whispering Pines, NC 28327
Phone (910) 215-5100

Interoperability endpoints

  • Direct secure messaging: ktillman11141@firsthealth.direct-ci.net

Organizations & group practices 12

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.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1567900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610064000000",
    "number": "1578112959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1197 S PLANK RD",
            "city": "SANFORD",
            "state": "NC",
            "postal_code": "273308620",
            "telephone_number": "919-356-2735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1411 GREENWAY CT",
            "city": "SANFORD",
            "state": "NC",
            "postal_code": "273306954",
            "telephone_number": "919-292-1878"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1197 S Plank Rd",
            "address_purpose": "LOCATION",
            "city": "Sanford",
            "state": "NC",
            "postal_code": "273308620",
            "country_code": "US",
            "telephone_number": "919-356-2735",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TILLMAN",
        "first_name": "KELLI",
        "middle_name": "MARIE BAKER",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-08",
        "last_updated": "2021-01-08",
        "certification_date": "2021-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "F06191243",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sanford, NC

Sources for this page

Verify at the official NPI Registry.