Justin Tilley

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-06938 Issued in NC

Practice address

1202 Medical Center Dr
Wilmington, NC 28401-7307

Phone

(910) 341-3300

Fax

(910) 251-2067

NPI assigned

Jan 5, 2017

Last updated

Jan 5, 2017By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Brody School of Medicine at East Carolina University, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Skin Surgery Center PAGroup PAC ID 3173599479, 72 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Skin Surgery Center PA

  • Dermatology Physician
  • Winston Salem, NC
  • NPI 1649237082
  Medicare reassignment Care Compare group
• Wilmington Health PLLC

  • Multi-Specialty Clinic/Center
  • Wilmington, NC
  • NPI 1881632339
  Medicare reassignment NPD
• Wilmington ASC LLC

  dba Wilmington Health Ambulatory Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Wilmington, NC
  • NPI 1548456478
  NPD
• Skin Surgery Center PA

  dba The Skin Surgery Center of Charleston

  • MOHS-Micrographic Surgery Physician
  • Mount Pleasant, SC
  • NPI 1851810279
  NPD

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

{
    "created_epoch": "1483574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1483574400000",
    "number": "1871038463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1202 MEDICAL CENTER DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284017307",
            "telephone_number": "910-341-3300",
            "fax_number": "910-251-2067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1202 MEDICAL CENTER DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284017307",
            "telephone_number": "910-341-3300",
            "fax_number": "910-251-2067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLEY",
        "first_name": "JUSTIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-01-05",
        "last_updated": "2017-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-06938",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lauren Maria Tiffany
• Dottie M Tighe, OTR/L
• Katherine A Tildes, NP
• Katy Joyner Till, BCBA
• Sarah Elizabeth Tiller, DPT
• Cassius Tilyou, PT, DPT
• Lacey Timmerman, RBT
• Tiffany Timpson, PA
• Timur Akinli, M.D., P.C. (Dr. Mur)
• Cortney Tindal, LCAS, LPCA, CRC

• Physician Assistant in Wilmington, NC
• Providers in Wilmington, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 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.