NPIMap

Individual provider Active NPI

Otis Edward Tillman Jr., M.D.

  • Specialist
  • Columbus, GA
National Provider Identifier
1962597385
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
040576 Issued in GA
Practice address
1942 North Avenue
Columbus, GA 31901
Phone
(706) 596-1245
Fax
(706) 576-4245
NPI assigned
Oct 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 040576 GA Primary

Addresses

Primary practice location

1942 North Avenue
Columbus, GA 31901

Mailing address

1942 North Avenue
Columbus, GA 31901
Phone (706) 596-1245

Other identifiers 3

IdentifierTypeStateIssuer
224251OtherGABCBS OF GEORGIA
60027547OtherALBCBS OF ALABAMA
00669127CMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL, GA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20090605000087 AL Practitioner - Internal Medicine 7810044161 Reassigns benefits to 1 organization
I20120119000132 GA Practitioner - Internal Medicine 7810044161 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Wake Forest University School of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Internal Medicine Associates of Columbus, LLCGroup PAC ID 5395739262, 3 clinicians

Practice addresses (Care Compare)

1942 N Ave
Columbus, GA 31901-1525
Phone (706) 596-1245

4401 River Chase Dr
Phenix City, AL 36867-7483
Phone (334) 732-3079

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.62 of 100Reported as apm
Quality
83.25
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
040576GAMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Columbus Ambulatory Healthcare Services, Inc. CurrentSince Oct 25, 2013 Accepting new patients
Internal Medicine Associates of Columbus, LLC Specialist CurrentSince Jan 1, 2003 Accepting new patients
Columbus Ambulatory Healthcare Services, Inc. CurrentSince Oct 25, 2013 Accepting new patients
Pulmonary Medicine Inc PastSince Jan 1, 2003 Accepting new patients
Rehabilitation Hospital of Columbus, LLC Past Accepting new patients

Locations

4401 Riverchase Dr
Phenix City, AL 36867
Phone (334) 732-3000

6801 River Rd
Ste 101
Columbus, GA 31904
Phone (706) 320-8625

1942 North Ave
Columbus, GA 31901
Phone (706) 320-8751

1800 10th Ave
Columbus, GA 31901
Phone (706) 571-1120

Organizations & group practices 5

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.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1962597385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1942 NORTH AVENUE",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "31901",
            "telephone_number": "706-596-1245",
            "fax_number": "706-576-4245"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1942 NORTH AVENUE",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "31901",
            "telephone_number": "706-596-1245",
            "fax_number": "706-576-4245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TILLMAN",
        "first_name": "OTIS",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "GA",
            "license": "040576",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF GEORGIA",
            "identifier": "224251",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF ALABAMA",
            "identifier": "60027547",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00669127C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, GA

Sources for this page

Verify at the official NPI Registry.