NPIMap

Individual provider Active NPI

Jerry Tilley

  • Case Manager/Care Coordinator
  • Winston Salem, NC
National Provider Identifier
1821327685
Registry record updated Dec 8, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Manager/Care CoordinatorTaxonomy code 171M00000X
License
HC3958 Issued in NC
Practice address
8005 N Point Blvd
Suite H
Winston Salem, NC 27106-3267
Phone
(336) 759-7207
Fax
(336) 759-7209
NPI assigned
Dec 8, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care Coordinator 171M00000X HC3958 NC Primary

Addresses

Primary practice location

8005 N Point Blvd
Suite H
Winston Salem, NC 27106-3267

Mailing address

8005 N Point Blvd
Suite H
Winston Salem, NC 27106-3267
Phone (336) 759-7207

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

NPI Registry JSON

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

{
    "created_epoch": "1260230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1260230400000",
    "number": "1821327685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8005 N POINT BLVD",
            "address_2": "SUITE H",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271063267",
            "telephone_number": "336-759-7207",
            "fax_number": "336-759-7209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8005 N POINT BLVD",
            "address_2": "SUITE H",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271063267",
            "telephone_number": "336-759-7207",
            "fax_number": "336-759-7209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLEY",
        "first_name": "JERRY",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-12-08",
        "last_updated": "2009-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NC",
            "license": "HC3958",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.