Kimberly A Tilghman-Burch, MD
Individual provider Active NPI Pediatrics Physician · South Fulton, TN
NPI 1972585065 · NPPES record last updated Mar 23, 2020
Key facts
- NPI
- 1972585065
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 37882 (KY)
- Practice address
- 1135 Broadway St
South Fulton, TN 38257-2835 - Phone
- (731) 479-2606
- Fax
- (731) 479-2610
- NPI assigned
- Nov 15, 2005
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200323001208 | TN | Practitioner - Pediatric Medicine | 9335238328 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 37882 | KY | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Martin Health | Current |
Accepting new patients | |
| Martin Health | Current |
Accepting new patients | |
| Martin Health | Past | Accepting new patients | |
| Martin Hospital Company LLC | Past | Accepting new patients |
Locations
1135 Broadway St
Ste A
South Fulton, TN 38257
Phone (731) 479-2606
1135 Broadway St
South Fulton, TN 38257
Phone (731) 479-2606
Interoperability endpoints
- kburch17996@directepic.wth.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 37882 | KY | Yes |
Addresses
Primary practice location
1135 Broadway St
South Fulton, TN 38257-2835
Mailing address
1804 Highway 45 Byp Ste 604
Jackson, TN 38305-4403
Phone (731) 660-7971
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000284799 | Other | KY | ANTHEM PROV NUMBER |
| 64065899 | Medicaid | KY |
Other providers in South Fulton, TN
- Rice Mobile OD TN LLC
- Charles Avery Rice
- Zearle Frances Robey
- Southside Drug Inc
- Audiene M Stoneham Nance
- Joshua Drew Whitledge
- Virgil Dale Yates
- Nathan Yoder
All providers in South Fulton, TN · Pediatrics Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 23, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.