Khadijah Ella Tillman, LCSW-R

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

081603 Issued in NY

Practice address

4 Chelmsford Rd.
Rochester, NY 14609

Phone

(585) 713-2071

NPI assigned

Apr 23, 2010

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sankofa Family Counseling Services LCSW PLLCGroup PAC ID 3072986934, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Sankofa Family Counseling Services, LCSW P.L.L.C.

  • Clinical Social Worker
  • Rochester, NY
  • NPI 1861047292
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1271980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492560000000",
    "number": "1851618391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 CHELMSFORD RD.",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "14609",
            "telephone_number": "585-713-2071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 CHELMSFORD RD.",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "14609",
            "telephone_number": "585-713-2071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLMAN",
        "first_name": "KHADIJAH",
        "middle_name": "ELLA",
        "credential": "LCSW-R",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-04-23",
        "last_updated": "2017-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "72074482",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "081603",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Megan Tifft, LMSW
• Sarah Marie Tiggelaar, M.D.
• Victoria Fern Tilbe, LCSW-R
• Becky A Tillett, RN
• Daisana Tillie
• Tamra Tills
• Tim'S Trim Inc.
• Rufus Johnston Timberlake, MD
• Timely Transportation Service
• Mary A Times, LPN

• Clinical Social Worker in Rochester, NY
• Providers in Rochester, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2017; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.