Active NPI
Richard A Tibbals, M.D.
- Otolaryngology Physician
- Evansville, IN
National Provider Identifier
1760441950
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- 01024335A
- Practice address
- 1020 Professional Blvd
Evansville, IN 47714-8009 - Phone
- (812) 473-2060
- Fax
- (812) 473-0763
- NPI assigned
- Mar 17, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | 01024335A | IN | Primary |
Addresses
Primary practice location
1020 Professional Blvd
Evansville, IN 47714-8009
Mailing address
1020 Professional Blvd
Evansville, IN 47714-8009
Phone (812) 473-2060
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 113537 | Other | IN | HEALTH ALLIANCE |
| 000000381551 | Other | IN | ANTHEM |
| 000000381551 | Other | KY | ANTHEM |
| 128718 | Other | IN | HEALTHLINK |
| 100246470A | Medicaid | IN | |
| P00280944 | Other | IN | RR MEDICARE |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01024335A | IN | MD | Otolaryngology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142553600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1321228800000",
"number": "1760441950",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1020 PROFESSIONAL BLVD",
"city": "EVANSVILLE",
"state": "IN",
"postal_code": "477148009",
"telephone_number": "812-473-2060",
"fax_number": "812-473-0763"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1020 PROFESSIONAL BLVD",
"city": "EVANSVILLE",
"state": "IN",
"postal_code": "477148009",
"telephone_number": "812-473-2060",
"fax_number": "812-473-0763"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIBBALS",
"first_name": "RICHARD",
"middle_name": "A",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-17",
"last_updated": "2011-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "IN",
"license": "01024335A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH ALLIANCE",
"identifier": "113537",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000381551",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000381551",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHLINK",
"identifier": "128718",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100246470A",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "P00280944",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Evansville, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.