Carla Rose Tillery, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

ME78611 Issued in FL

Practice address

1190 E Nine Mile Rd
Pensacola, FL 32514-1651

Phone

(850) 474-8771

Fax

(850) 479-9180

NPI assigned

Jul 17, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Pensacola Primary Care Inc

  • Family Medicine Physician
  • Pensacola, FL
  • NPI 1982643169
  Medicare reassignment NPD
• Pensacola Primary Care Inc

  • Family Medicine Physician
  • Milton, FL
  • NPI 1992828818
  NPD

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1286928000000",
    "number": "1770501280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1190 E NINE MILE RD",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325141651",
            "telephone_number": "850-474-8771",
            "fax_number": "850-479-9180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1190 E NINE MILE RD",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325141651",
            "telephone_number": "850-474-8771",
            "fax_number": "850-479-9180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLERY",
        "first_name": "CARLA",
        "middle_name": "ROSE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-17",
        "last_updated": "2010-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "ME78611",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "257288500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tiffany Chen
• Oruc Barkin Tig, MD
• Alexa Renee Tijerina
• Craig Michael Tilghman, MD
• Cynthia Tilghman
• Jeanne Rene' Tilley, NURSE PRACTITIONER
• Stephanie Flynn Tilley, DMD
• Michael Tillman, CRNA
• Todd Trevor Timko, D.M.D.
• Colleen Timmons

• Internal Medicine Physician in Pensacola, FL
• Providers in Pensacola, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 2010; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.