Hollis Tidmore, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

2009005897 Issued in MO

Practice address

1422 S Sam Houston Blvd
Houston, MO 65483-2130

Phone

(417) 967-1252

Fax

(417) 967-0417

NPI assigned

Jan 28, 2006

Sex

Male

Sole proprietor

No

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.

• Texas County Memorial Hospital

  • Clinic/Center
  • Houston, MO
  • NPI 1710926928
  Medicare reassignment NPD MO · SURGERY
• Capital Surgical Specialists, PA

  • Surgery Physician
  • Louisburg, NC
  • NPI 1730150558
  NPD (past) Authorized official SURGERY
• Texas County Memorial Hospital

  • Clinic/Center
  • Houston, MO
  • NPI 1497593719
  NPD
• Ozarks Medical Center

  • General Acute Care Hospital
  • West Plains, MO
  • NPI 1831115641
  NPD (past)
• North Carolina Surgical Associates, PLLC

  • Surgery Physician
  • Louisburg, NC
  • NPI 1518122167
  NPD (past) SURGERY

Merit-based Incentive Payment System (MIPS)

Final score

84.36 of 100Reported as group

Quality

56.69

Promoting interoperability

100

Improvement activities

40

Cost

84.94

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.

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: hollis.tidmore.1@11992.direct.athenahealth.com

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 31, 2023.

{
    "created_epoch": "1138406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675123200000",
    "number": "1962473975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1422 S SAM HOUSTON BLVD",
            "city": "HOUSTON",
            "state": "MO",
            "postal_code": "654832130",
            "telephone_number": "417-967-1252",
            "fax_number": "417-967-0417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1422 S SAM HOUSTON BLVD",
            "city": "HOUSTON",
            "state": "MO",
            "postal_code": "654832130",
            "telephone_number": "417-967-1252",
            "fax_number": "417-967-0417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIDMORE",
        "first_name": "HOLLIS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-28",
        "last_updated": "2023-01-31",
        "certification_date": "2023-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "MO",
            "license": "2009005897",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MO",
            "license": "2009005897",
            "primary": true
        },
        {
            "code": "2086S0127X",
            "taxonomy_group": "",
            "desc": "Surgery, Trauma Surgery",
            "state": "MO",
            "license": "2009005897",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "207050501",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Texas County Memorial Hospital
• Texas County Memorial Hospital
• Texas County Memorial Hospital
• Texas County Memorial Hospital
• Texas County Memorial Hospital
• Teresa Kathleen Vivod
• Wal-Mart Stores East LP
• Wal-Mart Stores East, LP
• Walgreen Co
• Brett L Welden, CRNA

• All providers in Houston, MO
• Surgery Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 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.