Active NPI
Jill Rogers Tisdale
- School Psychologist
- Lake City, SC
National Provider Identifier
1720426422
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- 180404
- Practice address
- 318 E Main St
Lake City, SC 29560-2116 - Phone
- (843) 374-2393
- Fax
- (843) 374-7245
- NPI assigned
- Jun 5, 2013
- 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 |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | 180404 | SC | Primary |
Addresses
Primary practice location
318 E Main St
Lake City, SC 29560-2116
Mailing address
PO Box 1389
Lake City, SC 29560-1389
Phone (843) 374-2393
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 180404 | SC | MD | School Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Florence County School District Three | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Local Education Agency (LEA)
- Lake City, SC
- NPI 1245288901
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1370390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1370390400000",
"number": "1720426422",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1389",
"city": "LAKE CITY",
"state": "SC",
"postal_code": "295601389",
"telephone_number": "843-374-2393",
"fax_number": "843-374-7245"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "318 E MAIN ST",
"city": "LAKE CITY",
"state": "SC",
"postal_code": "295602116",
"telephone_number": "843-374-2393",
"fax_number": "843-374-7245"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TISDALE",
"first_name": "JILL",
"middle_name": "ROGERS",
"name_prefix": "Mrs.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-06-05",
"last_updated": "2013-06-05",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "SC",
"license": "180404",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake City, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.