Individual provider Active NPI

Michael Tillman, CRNA

  • Certified Registered Nurse Anesthetist
  • Pensacola, FL
National Provider Identifier
1669910949
Registry record updated Feb 7, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
ARNP9321940 Issued in FL
Practice address
4901 Grande Dr
Pensacola, FL 32504-5935
Phone
(850) 477-7042
Fax
(850) 474-9060
NPI assigned
Feb 7, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X ARNP9321940 FL Primary

Addresses

Primary practice location

4901 Grande Dr
Pensacola, FL 32504-5935

Mailing address

4901 Grande Dr
Pensacola, FL 32504-5935
Phone (850) 477-7042

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171120001993 OK Practitioner - Certified Registered Nurse Anesthetist (Crna) 4789969031 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emergenchealth PLLCGroup PAC ID 1355606641, 1,037 clinicians
Triad Eye Institute PLLCGroup PAC ID 6507083557, 36 clinicians
South Tulsa Anesthesia LLCGroup PAC ID 1355634023, 4 clinicians

Practice addresses (Care Compare)

1120 S Utica Ave
HC Med Ctr
Tulsa, OK 74104-4012
Phone (918) 579-1000

6140 S Memorial Dr
Tulsa, OK 74133-1933
Phone (918) 252-2020

9840 E 81 St
Suite 200
Tulsa, OK 74133-4584
Phone (918) 872-8447

Hospital & facility affiliations

  • Hillcrest Medical Center Hospital, Tulsa, OK, CCN 370001

Merit-based Incentive Payment System (MIPS)

Final score
91.73 of 100Reported as group
Quality
95.73
Promoting interoperability
100
Improvement activities
40
Cost
76.7

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
South Tulsa Anesthesia LLC CurrentSince Jul 28, 2019 Accepting new patients
Langley Holdings, LLC Current Accepting new patients
Emergenchealth PLLC Nurse Anesthetist, Certified Registered CurrentSince Jun 1, 2019 Accepting new patients
Triad Eye Institute PLLC CurrentSince Jun 12, 2019 Accepting new patients

Locations

3615 SE Kentucky St
Bartlesville, OK 74006
Phone (800) 354-2020

1202 N Muskogee Pl
Claremore, OK 74017
Phone (918) 341-2556

1027 E Cherry St
Cushing, OK 74023
Phone (918) 225-2915

63223 E 290 Rd
Grove, OK 74344
Phone (918) 786-3931

2401 W Main St
Henryetta, OK 74437
Phone (918) 650-1100

1001 E Wyandotte Ave
McAlester, OK 74501
Phone (918) 302-9232

3131 Military Blvd
Muskogee, OK 74401
Phone (918) 290-2300

10512 N 110th East Ave
Owasso, OK 74055
Phone (918) 272-1172

111 N Bailey St
Pryor, OK 74361
Phone (918) 824-7791

8801 S 101st East Ave
Tulsa, OK 74133
Phone (800) 965-4565

6140 S Memorial Dr
Tulsa, OK 74133
Phone (918) 252-2020

1120 S Utica Ave
Tulsa, OK 74104
Phone (918) 579-6090

9840 E 81st St
Ste 200
Tulsa, OK 74133
Phone (918) 872-8447

7400 Barlite Blvd
San Antonio, TX 78224
Phone (210) 921-2000

Organizations & group practices 5

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 1

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": "1486425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486425600000",
    "number": "1669910949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4901 GRANDE DR",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325045935",
            "telephone_number": "850-477-7042",
            "fax_number": "850-474-9060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4901 GRANDE DR",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325045935",
            "telephone_number": "850-477-7042",
            "fax_number": "850-474-9060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLMAN",
        "first_name": "MICHAEL",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-02-07",
        "last_updated": "2017-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "FL",
            "license": "ARNP9321940",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pensacola, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.