ELBERT STINSON TILLERSON MD NPI 1003872714

Hospitalist in Jefferson City, MO

About ELBERT TILLERSON

Elbert Tillerson is a provider in Jefferson City, MO with more than 17 years of experience. The NPI number assigned to this provider is 1003872714. The practitioner's primary taxonomy code is Hospitalist (208M00000X). The provider is registered as an individual and their NPI record was last updated 5 years ago. Elbert Tillerson is registered with Medicare and accepts claims assignment.

NPI1003872714 Additional informationCallout TooltipNational Provider Indentifier (NPI)
The 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
Provider Name ELBERT STINSON TILLERSON MD
Provider Location Address1125 MADISON ST. JEFFERSON CITY, MO 65102 Additional informationCallout TooltipProvider location address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Mailing Address1125 MADISON ST. JEFFERSON CITY, MO 65102 Additional informationCallout TooltipProvider mailing address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.
GenderMale
NPI Entity TypeIndividual Additional informationCallout TooltipEntity type code
The code describing the type of health care provider that is being assigned an NPI.
Codes are:
1 = (Person): individual human being who furnishes health care;
2 = (Non-person): entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO).
Medical School NameMEDICAL UNIVERSITY OF SOUTH CAROLINA COLLEGE OF MEDICINE
Graduation Year2001
Is Sole Proprietor?No
Is Organization Subpart?N/A Additional informationCallout TooltipWhat is a subpart?
Subparts are the components and separate physical locations of organization health care providers. Examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.
Enumeration Date04-21-2006 Additional informationCallout TooltipProvider enumeration date
The date the provider was assigned a unique identifier (assigned an NPI)
Last Update Date01-15-2013 Additional informationCallout TooltipLast update date
The date that a record was last updated or changed.

Business Address

ELBERT STINSON TILLERSON MD
1125 MADISON ST.
JEFFERSON CITY, MO
ZIP 65102
Phone: (573) 635-7651
Fax: (573) 659-4515
Get Directions

Mailing Address

ELBERT STINSON TILLERSON MD
1125 MADISON ST.
JEFFERSON CITY, MO
ZIP 65102
Phone: (573) 635-7651
Fax: (573) 659-4515

Primary Taxonomy

Taxonomy Code208M00000X Additional informationCallout TooltipPrimary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
ClassificationHospitalist
TypeAllopathic & Osteopathic Physicians
License No.2011041481
License StateMO
Taxonomy DescriptionHospitalists are physicians whose primary professional focus is the general medical care of hospitalized patients. Their activities include patient care, teaching, research, and leadership related to Hospital Medicine. The term 'hospitalist' refers to physicians whose practice emphasizes providing care for hospitalized patients.

Secondary Taxonomies


The secondary taxonomy codes define the provider type, classification, and specialization. For individual NPIs the license data is associated to each taxonomy code.

No. Taxonomy Code Type Classification Specialization License No. State Primary
12084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry2011041481MONo

Taxonomy Description: a Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, anxiety disorders, substance-related disorders, sexual and gender identity disorders and adjustment disorders. Biologic, psychological, and social components of illnesses are explored and understood in treatment of the whole person. Tools used may include diagnostic laboratory tests, prescribed medications, evaluation and treatment of psychological and interpersonal problems with individuals and families, and intervention for coping with stress, crises, and other problems.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
054133OTHER (01)GA
23919OTHER (01)SC
1003872714MEDICAID (05)MO
I46657MEDICARE UPIN (02)GA

Map Location


ELBERT STINSON TILLERSON MD address is 1125 MADISON ST. JEFFERSON CITY, MO 65102

Other Providers at the same location


The following 2 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1497159933MRS. VASHTI A. IVEY FNP-C
Individual
Nurse Practitioner (Family)1125 MADISON ST.
JEFFERSON, MO 65102
(573) 632-5700
1801054622CAPITAL REGION MEDICAL CENTER
Organization
Surgery1125 MADISON ST.
JEFFERSON CITY, MO 65102
(573) 634-2620