Mark Tillotson, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

36841 Issued in NC

Practice address

257 Hospital Drive Suite 200
Bolivia, NC 28422-8411

Phone

(910) 721-4000

Fax

(910) 721-4001

NPI assigned

Dec 20, 2005

Last updated

May 11, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: mtillotson16738@direct.novanthealth.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• North Carolina Physician Network, Inc.

  dba Brunswick Women's Center

  • Obstetrics & Gynecology Physician
  • Supply, NC
  • NPI 1528058963
  NPD (past)

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

{
    "created_epoch": "1135036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683763200000",
    "number": "1649256850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447",
            "telephone_number": "704-384-7840",
            "fax_number": "704-384-7830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "257 HOSPITAL DRIVE SUITE 200",
            "city": "BOLIVIA",
            "state": "NC",
            "postal_code": "284228411",
            "telephone_number": "910-721-4000",
            "fax_number": "910-721-4001"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "584 Hospital Dr",
            "address_2": "SUITE A",
            "address_purpose": "LOCATION",
            "city": "Bolivia",
            "state": "NC",
            "postal_code": "28422",
            "country_code": "US",
            "telephone_number": "910-721-4000",
            "fax_number": "910-721-4001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TILLOTSON",
        "first_name": "MARK",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-20",
        "last_updated": "2023-05-11",
        "certification_date": "2023-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NC",
            "license": "36841",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NC LICENSE",
            "identifier": "36841",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8983552",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mtillotson16738@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "584 Hospital Dr",
            "address_2": "SUITE A",
            "city": "Bolivia",
            "state": "NC",
            "country_code": "US",
            "postal_code": "28422",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Surgery Physician in Bolivia, NC
• Providers in Bolivia, NC by specialty
• Surgery Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.