Charles H Tillman Jr., MD

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

36412 Issued in MO

Practice address

720 Medical Park Dr
Mexico, MO 65265-3726

Phone

(573) 581-3240

Fax

(573) 581-7493

NPI assigned

Sep 21, 2005

Last updated

Jul 28, 2023By 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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Cardiovascular Disease (Cardiology)Also: Internal Medicine

Education

University of Missouri, Columbia School of Medicine, 1982

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Chas Physician Services LLCGroup PAC ID 7810038064, 25 clinicians

Pike County Memorial HospitalGroup PAC ID 8123015518, shared by 6 NPIs, 31 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Boone Hospital Center Hospital, Columbia, MO, CCN 260068
• Pike County Memorial Hospital Hospital, Louisiana, MO, CCN 261333
• University of Missouri Health Care Hospital, Columbia, MO, CCN 260141

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Chas Physician Services LLC

  • Cardiovascular Disease Physician
  • Columbia, MO
  • NPI 1629301163
  Medicare reassignment Care Compare group NPD
• Mexico Cardiovascular Associates LLC

  • Cardiovascular Disease Physician
  • Mexico, MO
  • NPI 1952322893
  Authorized official Same address or phone
• Chas Physician Services, LLC

  • Pulmonary Disease Physician
  • Columbia, MO
  • NPI 1326312976
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• CH Allied Services, Inc

  dba Boone Hospital Center

  • Cardiac Rehabilitation Clinic/Center
  • Columbia, MO
  • NPI 1548734734

  Hospital

  Care Compare affiliation
• CH Allied Services, Inc.

  dba Boone Hospital Center

  • General Acute Care Hospital
  • Columbia, MO
  • NPI 1902817844
  Care Compare affiliation
• Curators of the University of Missouri

  dba Capital Region Medical Center

  • General Acute Care Hospital
  • Jefferson City, MO
  • NPI 1174597892
  Care Compare affiliation
• Curators of the University of Missouri

  dba University of Missouri Health Care

  • General Acute Care Hospital
  • Columbia, MO
  • NPI 1699769901
  Care Compare affiliation
• Pike County Memorial Hospital

  • Critical Access Hospital
  • Louisiana, MO
  • NPI 1205837218
  Care Compare affiliation

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

{
    "created_epoch": "1127260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690502400000",
    "number": "1891781225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 E MONROE ST",
            "city": "MEXICO",
            "state": "MO",
            "postal_code": "652652852",
            "telephone_number": "573-581-3240",
            "fax_number": "573-581-7493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 MEDICAL PARK DR",
            "city": "MEXICO",
            "state": "MO",
            "postal_code": "652653726",
            "telephone_number": "573-581-3240",
            "fax_number": "573-581-7493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLMAN",
        "first_name": "CHARLES",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-21",
        "last_updated": "2023-07-28",
        "certification_date": "2023-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MO",
            "license": "36412",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "202409801",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Humza Bin Waheed, M.D.
• Muhammad Waheed, STUDENT
• Shahid Waheed, M.D.

• Cardiovascular Disease Physician in Mexico, MO
• Providers in Mexico, MO by specialty
• Cardiovascular Disease Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2023; 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.