NPIMap

Individual provider Active NPI

Laura Tillman, M.D.

  • Surgery Physician
  • Phoenix, AZ
National Provider Identifier
1932295748
Registry record updated Mar 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
24835 Issued in AZ
Practice address
4212 N 16TH St
Phoenix, AZ 85016-5319
Phone
(602) 263-1200
Fax
(602) 263-1619
NPI assigned
Oct 5, 2006
Last updated
Mar 17, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 24835 AZ Primary

Addresses

Primary practice location

4212 N 16TH St
Phoenix, AZ 85016-5319

Mailing address

PO Box 95460
Cleveland, OH 44101-0033
Phone (602) 581-6076

Other identifiers 2

IdentifierTypeStateIssuer
AZ0722860OtherAZBCBS
483537MedicaidAZ

Other names 1

  • Laura O'Connor Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040907001023 TX Practitioner - General Surgery 8426024860 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
24835AZMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Dhew Ind HLTH SV HLTH SVS & MNTL HLTH Adm CurrentSince Jul 1, 2001 Accepting new patients
Dhew Ind HLTH SV HLTH SVS & MNTL HLTH Adm CurrentSince Jul 1, 2001 Accepting new patients

Locations

48203 W Farrell Rd
#H
Maricopa, AZ 85139
Phone (520) 568-3881

12033 Agency Rd
Parker, AZ 85344
Phone (760) 572-4137

4212 N 16th St
Phoenix, AZ 85016
Phone (602) 248-4187

Organizations & group practices 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773705600000",
    "number": "1932295748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 95460",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441010033",
            "telephone_number": "602-581-6076",
            "fax_number": "602-263-1619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4212 N 16TH ST",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850165319",
            "telephone_number": "602-263-1200",
            "fax_number": "602-263-1619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLMAN",
        "first_name": "LAURA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-05",
        "last_updated": "2026-03-17",
        "certification_date": "2026-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AZ",
            "license": "24835",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "AZ0722860",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "483537",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAURA",
            "last_name": "O'CONNOR",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Phoenix, AZ

Sources for this page

Verify at the official NPI Registry.