Active NPI
Mary Kate Tillman, M.D.
- Pediatrics Physician
- Summerville, SC
National Provider Identifier
1669451092
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 16816
- Practice address
- 202 Bentons Lodge Rd
Summerville, SC 29485-6322 - Phone
- (843) 871-2588
- Fax
- (843) 871-1664
- NPI assigned
- Jan 13, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 16816 | SC | Primary |
Addresses
Primary practice location
202 Bentons Lodge Rd
Summerville, SC 29485-6322
Mailing address
202 Bentons Lodge Rd
Summerville, SC 29485-6322
Phone (843) 871-2588
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 168160 | Medicaid | SC |
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16816 | SC | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sweetgrass Pediatrics | Pediatrics | Past | Accepting new patients |
| Oakbrook Pediatrics, PA | Pediatrics | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Pediatrics Physician
- Summerville, SC
- NPI 1760456909
-
- Pediatrics Physician
- North Charleston, SC
- NPI 1437168135
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137110400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1490572800000",
"number": "1669451092",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "202 BENTONS LODGE RD",
"city": "SUMMERVILLE",
"state": "SC",
"postal_code": "294856322",
"telephone_number": "843-871-2588",
"fax_number": "843-871-1664"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "202 BENTONS LODGE RD",
"city": "SUMMERVILLE",
"state": "SC",
"postal_code": "294856322",
"telephone_number": "843-871-2588",
"fax_number": "843-871-1664"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TILLMAN",
"first_name": "MARY KATE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-01-13",
"last_updated": "2017-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "SC",
"license": "16816",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "168160",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Summerville, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.