NPIMap

Organization Active NPI

William a. Tisdall, M.D., P.a.

  • Interventional Pain Medicine Physician
  • San Antonio, TX
National Provider Identifier
1598085243
Registry record updated Apr 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
Legal business name
WILLIAM A. TISDALL, M.D., P.A.
Practice address
1919 Rogers Rd
Suite 104
San Antonio, TX 78251-4614
Phone
(210) 541-0700
Fax
(210) 514-6868
NPI assigned
Jun 4, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2018

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

Authorized official

Name
Dr. William Alec Tisdall, M.D.NPI 1124153754
Title
President
Phone
(210) 541-0700

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207LP2900X
Interventional Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0014X Primary

Addresses

Primary practice location

1919 Rogers Rd
Suite 104
San Antonio, TX 78251-4614

Mailing address

1919 Rogers Rd
Suite 204
San Antonio, TX 78251-4614
Phone (210) 541-0700

Other identifiers 2

IdentifierTypeStateIssuer
217091201MedicaidTX
0039TQOtherTXBLUE CROSS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100914001282 TX Part B Supplier - Clinic/Group Practice 2860517877 Receives reassigned benefits from 9 practitioners
Practice locations: Schertz, TX; Spring Branch, TX; San Antonio, TX
O20160415000277 TX DME Supplier - Physician - Interventional Pain Management 2860517877 Practice locations: San Antonio, TX

National Provider Directory

National Provider Directory

Locations

524 Singing Oaks
Ste 280
Bulverde, TX 78070
Phone (210) 615-7171

1919 Rogers Rd
Ste 204
San Antonio, TX 78251

1919 Rogers Rd
San Antonio, TX 78251

1314 E Sonterra Blvd
Ste 2107
San Antonio, TX 78258

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1275609600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522886400000",
    "number": "1598085243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1919 ROGERS RD",
            "address_2": "SUITE 204",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782514614",
            "telephone_number": "210-541-0700",
            "fax_number": "210-514-6868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1919 ROGERS RD",
            "address_2": "SUITE 104",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782514614",
            "telephone_number": "210-541-0700",
            "fax_number": "210-514-6868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLIAM A. TISDALL, M.D., P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-04",
        "last_updated": "2018-04-05",
        "status": "A",
        "authorized_official_last_name": "TISDALL",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "ALEC",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "210-541-0700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "217091201",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "0039TQ",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.