Jason Scott Lilly, DMD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

TN9847 Issued in TN

Practice address

2285 Rudolphtown Rd
Clarksville, TN 37043

Phone

(931) 552-3292

Fax

(931) 552-3243

NPI assigned

May 18, 2010

Last updated

Jun 24, 2024By 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 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jul 26, 2023 through Jul 26, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1274140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719187200000",
    "number": "1912226895",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2285 RUDOLPHTOWN RD",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "37043",
            "telephone_number": "931-552-3292",
            "fax_number": "931-552-3243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2285 RUDOLPHTOWN RD",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "37043",
            "telephone_number": "931-552-3292",
            "fax_number": "931-552-3243"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6225 W Highway 146",
            "address_purpose": "LOCATION",
            "city": "Crestwood",
            "state": "KY",
            "postal_code": "400147595",
            "country_code": "US",
            "telephone_number": "859-278-9376",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4515 Churchman Ave",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402151172",
            "country_code": "US",
            "telephone_number": "859-278-9376",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2524 Highway 49 E Ste C",
            "address_purpose": "LOCATION",
            "city": "Pleasant View",
            "state": "TN",
            "postal_code": "371467200",
            "country_code": "US",
            "telephone_number": "931-552-3292",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1275 Parkway Pl",
            "address_purpose": "LOCATION",
            "city": "Clarksville",
            "state": "TN",
            "postal_code": "370428402",
            "country_code": "US",
            "telephone_number": "931-552-3292",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LILLY",
        "first_name": "JASON",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-05-18",
        "last_updated": "2024-06-24",
        "certification_date": "2024-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TN",
            "license": "9847",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "KY",
            "license": "11096",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TN",
            "license": "TN9847",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Elizabeth Lima
• Sara Josephine Linares, RBT
• Lincare Inc.

• Oral and Maxillofacial Surgery (Dentist) in Clarksville, TN
• Providers in Clarksville, TN by specialty
• Oral and Maxillofacial Surgery (Dentist) in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2024; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.