MR. DONALD GREGORY TISDALE JR. NP
NPI 1174006522
Nurse Practitioner - Family in Flowood, MS

Q: What is Donald Tisdale's NPI number?

The NPI number for Donald Tisdale is 1174006522. It was assigned to this individual provider in the NPPES registry on September 12, 2018. The provider is also known as Greg Tisdfale Np.

Q: What is Donald Tisdale's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Q: When was this NPI record last updated?

The NPPES record for Donald Tisdale was last updated on May 26, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since September 12, 2018PECOS EnrolledAccepts Medicare Assignment

10 CANEBRAKE BLVD STE 110-09, FLOWOOD, MS 39232(769) 333-8808(769) 333-8809 Get Directions Write a Review

NPPES record last updated: May 26, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: May 26, 2021, Aug 9, 2019, Sep 12, 2018 (3 updates tracked since 2018).

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About Mr. Donald Gregory Tisdale Jr. Np NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. DONALD GREGORY TISDALE JR. NP (NPI 1174006522) is an individual family provider in Flowood, Mississippi, licensed in Mississippi (902899) and active in the NPI registry since September 2018. He is enrolled in Medicare PECOS, is affiliated with St Dominic-jackson Memorial Hospital, and maintains a secondary practice location in Jackson.

NPPES Registry Identity

NPI1174006522

Entity TypeIndividualMale

Primary Taxonomy363LF0000X

Provider Legal NameMR. DONALD GREGORY TISDALE JR.Credential: NP

Location Address10 CANEBRAKE BLVD STE 110-09Flowood, MS 39232-2211

Mailing Address10 Canebrake Blvd Ste 110-09Flowood, MS 39232-2211 · (769) 333-8808 · Fax (769) 333-8809

Phone(769) 333-8808

Fax(769) 333-8809

Sole ProprietorYes

Medical School CMSOtherGraduated 2018

Enumeration DateSeptember 12, 2018

Last NPPES UpdateMay 26, 20213 updates tracked since enumeration

NPPES CertifiedMay 26, 2021

✔ NPI 1174006522 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

License✔ Licensed in MS · 902899

10 CANEBRAKE BLVD STE 110-09, Flowood, MS 39232

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Other Names 1

Other Name (5)Greg Tisdfale Np

Secondary Practice Location 1

Location 11227 N State St Ste 101Jackson, MS 39202-2002 · Phone (601) 355-2485

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mr. Donald Gregory Tisdale Jr. Np is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2062751076

PECOS Enrollment IDI20190307003176

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 16

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Residence visit for established patient with high level of medical decision making, per day, if using time, at least 60 minutes 99350

An established patient home visit is a service where a healthcare professional visits a patient's home for a check-up or treatment. The visit typically lasts for about an hour. This service is especially beneficial for patients who may have difficulty traveling to a healthcare facility.

576 services165 patients

Residence visit for established patient with moderate level of medical decision making, per day, if using time, at least 40 minutes 99349

An established patient home visit is a medical appointment conducted at your home, typically lasting around 40 minutes. This service is ideal for patients who may find it difficult to travel to a healthcare facility. During this visit, a healthcare professional will evaluate your health status, manage your care, and answer any health-related questions you may have.

204 services52 patients

Administration of influenza virus vaccine G0008

The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.

191 services187 patients

Influenza vaccine, inactivated 90653

The Influenza vaccine, inactivated, is a shot given to protect against the flu. It contains killed virus particles that help your body build immunity to the flu. It's recommended annually to keep your protection up-to-date. It's safe for ages 6 months and up.

181 services181 patients

Insertion of needle into vein for collection of blood sample 36415

This procedure involves inserting a small needle into a vein, typically in your arm, to collect a blood sample. It's a quick and simple process to help diagnose or monitor health conditions. You may feel a small prick, but discomfort is minimal.

133 services77 patients

Physician or allowed practitioner supervision of a patient receiving medicare-covered services provided by a participating home health agency (patient not present) requiring complex and multidisciplinary care modalities involving regular physician or allow G0181

This service involves a physician overseeing your care while you receive Medicare-covered services from a home health agency. The care you're receiving is complex and involves various disciplines. The physician isn't physically present but regularly supervises your treatment to ensure optimal health outcomes.

69 services22 patients

Residence visit for new patient with high level of medical decision making, per day, if using time, at least 75 minutes 99345

A new patient home visit is a comprehensive 75-minute appointment conducted at your home. The healthcare professional will assess your health, discuss any concerns, and create a personalized care plan. It's convenient, comfortable, and tailored to your specific needs.

60 services60 patients

Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439

An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.

50 services50 patients

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

47 services28 patients

Pneumococcal conjugate vaccine, 20 valent (pcv20), for intramuscular use 90677

The Pneumococcal Conjugate Vaccine (PCV20) is a shot given to protect against 20 types of bacteria that can cause serious infections like pneumonia and meningitis. It's administered through a muscle, usually in the arm. It's important for overall health.

25 services25 patients

Administration of pneumococcal vaccine G0009

The pneumococcal vaccine helps protect against pneumococcal bacteria, which can cause severe infections like pneumonia and meningitis. The vaccine is given as an injection, typically in the arm. It's recommended for infants, older adults, and those with certain health conditions.

25 services25 patients

Removal of impacted ear wax 69210

Impacted ear wax removal is a safe procedure to clear blockages in the ear canal caused by hardened ear wax. A healthcare professional uses specialized tools or a gentle irrigation method to loosen and remove the wax, improving hearing and alleviating discomfort.

23 services18 patients

Physician or allowed practitioner re-certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians a G0179

This procedure involves a doctor or approved practitioner reviewing your health status and re-certifying your need for Medicare-covered home health services. It includes communication with the home health agency and assessment of your health reports, even when you're not physically present.

20 services15 patients

Physician or allowed practitioner certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians and G0180

This is a service where a doctor or authorized practitioner certifies that you require Medicare-covered home health services. They will communicate with the home health agency and review reports on your health status to ensure you receive appropriate care. This does not involve an in-person visit.

14 services13 patients

Amplifed dna or rna probe detection of severe acute respiratory syndrome coronavirus 2 (covid-19) antigen 87635

This is a lab test that detects the presence of COVID-19 in your body. It uses a technique to amplify the virus's genetic material, either DNA or RNA, making it easier to identify. A positive result indicates an active infection.

11 services11 patients

Transitional care management services for problem of high complexity 99496

Transitional care management services are designed to ensure a smooth transition from a hospital to home or another care setting for patients with complex health issues. These services include medication management, patient education, and coordination with healthcare providers.

11 services11 patients

Hospital Affiliations CMS Care Compare 3

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

St Dominic-Jackson Memorial Hospital

Acute Care Hospitals · Jackson, MS

2/5 CMS rating

OwnershipVoluntary non-profit - Church

CMS Certification Number250048

Location969 Lakeland DrJackson, MS 39216 · Hinds County

Emergency services Birthing friendly

Yalobusha General Hospital

Acute Care Hospitals · Water Valley, MS

OwnershipGovernment - Local

CMS Certification Number250061

Location630 South Main StreetWater Valley, MS 38965 · Yalobusha County

Mississippi Baptist Medical Center

Acute Care Hospitals · Jackson, MS

2/5 CMS rating

OwnershipVoluntary non-profit - Private

CMS Certification Number250102

Location1225 N State StJackson, MS 39202 · Hinds County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 39232 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$80.50 typical visit price

range $51.65 – $159.18

Typical copayment $20.12 (range $12.91 – $39.79)

Most-billed visit code 99203

Established Patient

$92.20 typical visit price

range $16.15 – $129.61

Typical copayment $23.05 (range $4.03 – $32.40)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Referred Medical Equipment & Supplies CMS DME claims 5

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Ostomy skin barrier, with flange (solid, flexible or accordion), extended wear, without built-in convexity, 4 x 4 inches or smaller, each A4409

DME-Orthotic Devices · category DF010N

1 supplier12 claims240 services$6.00 avg. paid by Medicare

Ostomy pouch, drainable; for use on barrier with flange (2 piece system), each A5063

DME-Orthotic Devices · category DF010N

2 suppliers14 claims270 services$2.50 avg. paid by Medicare

Skin barrier, wipes or swabs, each A5120

DME-Orthotic Devices · category DF010N

1 supplier12 claims300 services$0.21 avg. paid by Medicare

Hospital bed, semi-electric (head and foot adjustment), with any type side rails, without mattress E0261

DME-Hospital Beds · category DB000N

1 supplier21 claims22 services$44.85 avg. paid by Medicare

Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service K0553

DME-Other DME · category DE017N

2 suppliers11 claims13 services$184.94 avg. paid by Medicare

Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

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Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ON-SITE HEALTH LLC

Nurse Practitioner (Family)

10 CANEBRAKE BLVD STE 110-09
FLOWOOD, MS 39232

Rankin County (769) 333-8808

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Donald Tisdale's NPI number?

The NPI number for Donald Tisdale is 1174006522. It was assigned to this individual provider in the NPPES registry on September 12, 2018. The provider is also known as Greg Tisdfale Np.

Where is Donald Tisdale located?

Donald Tisdale practices at 10 Canebrake Blvd Ste 110-09, Flowood, MS 39232. The listed phone number is (769) 333-8808.

What is Donald Tisdale's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Donald Tisdale enrolled in Medicare?

Yes. Donald Tisdale is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Is Donald Tisdale affiliated with any hospitals?

According to CMS data, Donald Tisdale is affiliated with St Dominic-Jackson Memorial Hospital, Yalobusha General Hospital and Mississippi Baptist Medical Center.

When was this NPI record last updated?

The NPPES record for Donald Tisdale was last updated on May 26, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.