Michelle Bane Tiller, PSYD
Individual provider Active NPI Psychologist · Harrison City, PA
NPI 1619082476 · NPPES record last updated Oct 6, 2021
Key facts
- NPI
- 1619082476
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- PS015111 (PA)
- Practice address
- 3777 Route 130 Suite 2
Harrison City, PA 15636-1260 - Phone
- (412) 378-1058
- NPI assigned
- Aug 20, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Clinical Psychologist
- Education
- Other, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Positive Directions Psychological Services
Practice addresses (Care Compare)
3344 Route 130
Suite D
Harrison City, PA 15636-1205
Phone (214) 573-1310
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140827002526 | PA | Practitioner - Clinical Psychologist | 3971721226 |
Reassigns benefits to 1 organization Practice locations: Harrison City, PA |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PS015111 | PA | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Positive Directions Psychological Services | Current |
Accepting new patients | |
| Alliance Health Wraparound Allegheny Inc | Psychologist | Past | Accepting new patients |
Locations
3344 Route 130
Ste D
Harrison City, PA 15636
Phone (214) 573-1310
3344 Route 130
Harrison City, PA 15636
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PS015111 | PA | Yes |
Addresses
Primary practice location
3777 Route 130 Suite 2
Harrison City, PA 15636-1260
Mailing address
3777 Route 130 Suite 2
Harrison City, PA 15636-1260
Phone (412) 378-1058
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| SA056569 | Medicaid | PA |
Other names
- Michelle Santilli
Other providers in Harrison City, PA
- Sarah Reagan
- Jennifer L Smith
- Stewart Chiropractic Center, PC
- Jeffery David Stewart
- Marie Kwai-Che Tan
- TK Diagnostic LLC
All providers in Harrison City, PA · Psychologist in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 6, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.