Individual provider Active NPI

Cheryl A Tillson, CRNA

  • Certified Registered Nurse Anesthetist
  • Charlotte, NC
National Provider Identifier
1922054766
Registry record updated Aug 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
050634 Issued in NC
Practice address
200 Hawthorne LN
Charlotte, NC 28204-2515
Phone
(704) 384-4239
Fax
(704) 384-5636
NPI assigned
May 25, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 50634 NC
Certified Registered Nurse Anesthetist 367500000X 050634 NC Primary

Addresses

Primary practice location

200 Hawthorne LN
Charlotte, NC 28204-2515

Mailing address

PO Box 601549
Charlotte, NC 28260-1549
Phone (704) 384-4239

Other identifiers 2

IdentifierTypeStateIssuer
NAN535MedicaidSC
8051440MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20050215000228 NC Practitioner - Certified Registered Nurse Anesthetist (Crna) 5294787545 Reassigns benefits to 4 organizations
I20200610003355 SC Practitioner - Certified Registered Nurse Anesthetist (Crna) 5294787545 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Charlotte Gastroenterology and Hepatology PLLCGroup PAC ID 3870489412, shared by 3 NPIs, 76 clinicians

Practice addresses (Care Compare)

2015 Randolph Rd
Suite 208
Charlotte, NC 28207-1200
Phone (704) 377-4009

Merit-based Incentive Payment System (MIPS)

Final score
95.22 of 100Reported as group
Quality
100
Promoting interoperability
100
Improvement activities
40
Cost
84.08

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
050634NCMDCertified Registered Nurse Anesthetist
50634NCMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Carolina Regional Anesthesia PLLC Anesthesiology CurrentSince Dec 1, 2019 Accepting new patients
SC Anesthesiology LLC Anesthesiology CurrentSince Jan 23, 2021 Accepting new patients
Carolina Anesthesia Associates PA Anesthesiology CurrentSince Dec 1, 2019 Accepting new patients
Charlotte Gastroenterology & Hepatology, PLLC CurrentSince Mar 1, 2022 Accepting new patients
Charlotte Gastroenterology & Hepatology, PLLC CurrentSince Mar 1, 2022 Accepting new patients
Mooresville Hospital Management Associates, LLC Nurse Anesthetist, Certified Registered Past Accepting new patients
Charlotte Gastroenterology & Hepatology, PLLC Past Accepting new patients
The Presbyterian Hospital Nurse Anesthetist, Certified Registered Past Accepting new patients
Mooresville Hospital Management Associates LLC Past Accepting new patients
Carolinas Medical Center - University Nurse Anesthetist, Certified Registered Past Accepting new patients
The Charlotte-Mecklenburg Hospital Authority Past Accepting new patients

Locations

200 Hawthorne Ln
Charlotte, NC 28204
Phone (704) 377-2424

2015 Randolph Rd
Ste 101
Charlotte, NC 28207
Phone (704) 602-6544

15830 Ballantyne Medical Pl
Ste 175
Charlotte, NC 28277
Phone (704) 323-7633

2015 Randolph Rd
Ste 208
Charlotte, NC 28207
Phone (704) 602-6544

3312 Battleground Ave
Greensboro, NC 27410
Phone (336) 282-5000

242A 9th Avenue Dr NE
Hickory, NC 28601
Phone (828) 327-6673

415 N Center St
Ste 201
Hickory, NC 28601

13808 Professional Center Dr
Huntersville, NC 28078
Phone (704) 717-5549

115 Commerce Pointe Blvd
Mooresville, NC 28117
Phone (423) 343-7032

110 Dennis Dr
Sanford, NC 27330
Phone (919) 774-4511

5115 Oleander Dr
Wilmington, NC 28403
Phone (910) 362-1011

1520 Taylor St
Columbia, SC 29201
Phone (803) 254-8449

11 Gateway Corners Park
Columbia, SC 29203
Phone (803) 462-2300

1920 Pickens St
Columbia, SC 29201
Phone (803) 254-7732

101 Surgeons Dr
Myrtle Beach, SC 29579
Phone (803) 504-7194

Organizations & group practices 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691539200000",
    "number": "1922054766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 601549",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282601549",
            "telephone_number": "704-384-4239",
            "fax_number": "704-384-5636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 HAWTHORNE LN",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282042515",
            "telephone_number": "704-384-4239",
            "fax_number": "704-384-5636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLSON",
        "first_name": "CHERYL",
        "middle_name": "A",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-25",
        "last_updated": "2023-08-09",
        "certification_date": "2023-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NC",
            "license": "50634",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NC",
            "license": "050634",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NAN535",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8051440",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.