Tilley Diagnostic Clinic

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

C7758 Issued in AR

Legal business name

TILLEY DIAGNOSTIC CLINIC

Practice address

1003 Schneider Dr
Malvern, AR 72104-4811

Phone

(501) 337-5678

Fax

(501) 332-6759

NPI assigned

Aug 5, 2006

Organization subpart

No

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

Authorized official

Name

Absalom H Tilley, M.D.

Title

Owner

Phone

(501) 337-5678

Specialties & licenses 6

Addresses

Other identifiers 1

Other names 1

• Pinnacle Physicians Group Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sandy Lynn King, APRN

  • Family Nurse Practitioner
  • Hot Springs, AR
  • NPI 1972270445
  NPD (past)

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607472000000",
    "number": "1831108331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1003 SCHNEIDER DR",
            "city": "MALVERN",
            "state": "AR",
            "postal_code": "721044811",
            "telephone_number": "501-337-5678",
            "fax_number": "501-332-6759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1003 SCHNEIDER DR",
            "city": "MALVERN",
            "state": "AR",
            "postal_code": "721044811",
            "telephone_number": "501-337-5678",
            "fax_number": "501-332-6759"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TILLEY DIAGNOSTIC CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-05",
        "last_updated": "2020-12-09",
        "certification_date": "2020-12-09",
        "status": "A",
        "authorized_official_last_name": "TILLEY",
        "authorized_official_first_name": "ABSALOM",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "501-337-5678",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "AR",
            "license": "C7758",
            "primary": true
        },
        {
            "code": "207RR0500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Rheumatology",
            "state": "AR",
            "license": "E5172",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "AR",
            "license": "E5062",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": "AR",
            "license": "GL008",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "AR",
            "license": "P01341",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "AR",
            "license": "A01943",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "149122002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pinnacle Physicians Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Pinnacle Physicians Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• The Crossing at Malvern
• Theraputic Family Services
• Pamela J Thomas, MHPP
• Julie A Thompson, COTA/L
• Jamall Tidwell, MHPP
• Absalom H Tilley, M.D.
• Tisha R. Jenkins, LCSW P.a.
• Makayla Tolliver
• Jasmine Traylor
• Martrel M Traylor, RECOVERY ASSISTANT

• Internal Medicine Physician in Malvern, AR
• Providers in Malvern, AR by specialty
• Internal Medicine Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2020; 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.