Brett Bienville Tisdale, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

13987 Issued in MS

Practice address

1017 Delaware Ave
McComb, MS 39648-3827

Phone

(601) 250-1122

Fax

(601) 250-0290

NPI assigned

Jan 10, 2006

Last updated

Mar 16, 2015By 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

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Emergency Medicine

Education

Louisiana State University School of Medicine in New Orleans, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Statcare PLLCGroup PAC ID 5799764965, 9 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Southwest Ms Regional Medical Center Hospital, McComb, MS, CCN 250097

Merit-based Incentive Payment System (MIPS)

Final score

30.33 of 100Reported as individual

Quality

60.65

Improvement activities

0

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: btisdale@sp-ms.direct.office.nextgen.com
• FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

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.

• Statcare PLLC

  • Clinic/Center
  • McComb, MS
  • NPI 1174579338

  Emergency Medicine

  Medicare reassignment Care Compare group NPD
• Gulfport Emergency Physicians

  • Emergency Medicine Physician
  • Gulfport, MS
  • NPI 1467400887
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Southwest Mississippi Regional Medical Center

  • General Acute Care Hospital
  • McComb, MS
  • NPI 1407805971
  Care Compare affiliation

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

{
    "created_epoch": "1136851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426464000000",
    "number": "1699754572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1017 DELAWARE AVE",
            "city": "MCCOMB",
            "state": "MS",
            "postal_code": "396483827",
            "telephone_number": "601-250-1122",
            "fax_number": "601-250-0290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1017 DELAWARE AVE",
            "city": "MCCOMB",
            "state": "MS",
            "postal_code": "396483827",
            "telephone_number": "601-250-1122",
            "fax_number": "601-250-0290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TISDALE",
        "first_name": "BRETT",
        "middle_name": "BIENVILLE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-10",
        "last_updated": "2015-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MS",
            "license": "13987",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Thornton, CFNP
• Thrift Drugs 2
• Thrift Home Care, Inc
• Sonja Thurman
• Alice P Thweott
• Titan Prosthetics Inc
• Candice Todd, PCMHT
• Myrtis M Tolliver, LSW
• Charles Tomba
• Total Quality Healthcare

• Emergency Medicine Physician in McComb, MS
• Providers in McComb, MS by specialty
• Emergency Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.