NPIMap

Individual provider Active NPI

Brent Justin Tilseth, M.D.

  • Diagnostic Radiology Physician
  • Jacksonville, FL
National Provider Identifier
1770905085
Registry record updated Mar 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
ME142293 Issued in FL
Practice address
2080 Child St
Jacksonville, FL 32214-5005
Phone
(904) 542-7300
NPI assigned
Jan 7, 2014
Last updated
Mar 28, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 28, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X ME142293 FL Primary

Addresses

Primary practice location

2080 Child St
Jacksonville, FL 32214-5005

Mailing address

5000 US Highway 17 Ste 18-200
Fleming Island, FL 32003-8231

Other practice location 1

52 W Underwood St
Orlando, FL 32806-1110
Phone (321) 842-8475

Other identifiers 4

IdentifierTypeStateIssuer
PS650OtherFLMEDICARE PTAN OHMG
O9423OtherFLMEDICARE PTAN OHRI
112609100MedicaidFL
XAEAAOtherFLBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200130002690 FL Practitioner - Diagnostic Radiology 6305272972 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orlando Health Medical Group IncGroup PAC ID 9537059084, 2,171 clinicians
Ohri LLCGroup PAC ID 4981912169, 130 clinicians

Practice addresses (Care Compare)

1414 Kuhl Ave
Orlando, FL 32806-2008
Phone (407) 841-5111

398 E Altamonte Dr
Altamonte Springs, FL 32701-4402
Phone (407) 331-9355

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
79.91 of 100Reported as group
Quality
61.18
Promoting interoperability
100
Improvement activities
40
Cost
71.86

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Ohri, LLC Single Specialty CurrentSince Feb 1, 2022 Accepting new patients
Ohri, LLC CurrentSince Feb 1, 2022 Accepting new patients
Orlando Health, Inc. Current Accepting new patients
Orlando Health Medical Group Inc CurrentSince Oct 1, 2022 Accepting new patients
Ohi West Medical Group, LLC Diagnostic Radiology CurrentSince Nov 2, 2023 Accepting new patients
Ohri, LLC Single Specialty Current Accepting new patients
Enloe Medical Center Single Specialty CurrentSince Mar 5, 2020 Accepting new patients
Orlando Health Medical Group Inc Single Specialty CurrentSince Oct 1, 2022 Accepting new patients
Enloe Medical Center CurrentSince Mar 5, 2020 Accepting new patients
Bayfront Health Imaging Center LLC Diagnostic Radiology Past Accepting new patients

Locations

398 E Altamonte Dr
Altamonte Springs, FL 32701
Phone (407) 331-3955

1414 Kuhl Ave
Orlando, FL 32806
Phone (407) 464-9516

32 W Gore St
Orlando, FL 32806
Phone (321) 841-3820

52 Underwood St
Orlando, FL 32806
Phone (321) 841-3581

9400 Turkey Lake Rd
Orlando, FL 32819
Phone (321) 843-5500

9400 Turkey Lake Rd
#P
Orlando, FL 32819
Phone (407) 351-8519

2201 Central Ave
#100
St Petersburg, FL 33713
Phone (727) 321-7057

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: btilseth281750@orlandohealth.medalliesdirect.net

Organizations & group practices 10

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.

Hospital & facility affiliations 6

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": "1389052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679961600000",
    "number": "1770905085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5000 US HIGHWAY 17 STE 18-200",
            "city": "FLEMING ISLAND",
            "state": "FL",
            "postal_code": "320038231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2080 CHILD ST",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322145005",
            "telephone_number": "904-542-7300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "52 W Underwood St",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328061110",
            "country_code": "US",
            "telephone_number": "321-842-8475",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TILSETH",
        "first_name": "BRENT",
        "middle_name": "JUSTIN",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-01-07",
        "last_updated": "2023-03-28",
        "certification_date": "2023-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "FL",
            "license": "ME142293",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN OHMG",
            "identifier": "PS650",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN OHRI",
            "identifier": "O9423",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112609100",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "XAEAA",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.