DR. WILLIAM JAMES TIDWELL (MD) – MOHS-Micrographic Surgery Physician, NPI 1962849463
MOHS-Micrographic Surgery Physician
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Doctor Profile
Contacts
Profile Insights
NPPES metrics only — not quality of care.
2,140 DERMATOLOGY in CA
Provider Addresses for DR. WILLIAM JAMES TIDWELL (MD)
26732 CROWN VALLEY PKWY STE 571
MISSION VIEJO, CA 926917305
Phone: (949) 200-7008
Fax: (855) 553-6013
Type: Mailing
107 GLIDEPATH WAY
LEBANON, TN 370904133
Phone: (615) 449-5771
Fax: (615) 449-5740
Type: Mailing
100 SPRINGHOUSE CT
HENDERSONVILLE, TN 370751609
Phone: (615) 824-7491
Fax: (615) 449-5740
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 147 Open Payments records for all available years, with a total value of $3,443.
Total Amount is formed as General ($3,443) + Research ($0) + Ownership ($0) = $3,443.
Last reported payment date: 2024-12-20 • Largest payer in this snapshot: ABBVIE INC. ($1,083).
Total Amount
$3,443
General + Research + Ownership
Payments
147
Total payment records
General Amount
$3,443
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-20
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ABBVIE INC. | $1,083 |
| Janssen Biotech, Inc. | $368 |
| GENZYME CORPORATION | $326 |
| E.R. Squibb & Sons, L.L.C. | $141 |
| Sun Pharmaceutical Industries Inc. | $133 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2021-01-26
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20210126000052 | I | Dermatology | TN | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 17003 | Destruction of precancer skin growth, 2-14 growths | 564 | 108 | $0 |
| 17311 | Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks | 347 | 272 | $0 |
| 17000 | Destruction of precancer skin growth, 1 growth | 244 | 171 | $0 |
| 11102 | Biopsy of related skin growth, first growth | 169 | 139 | $0 |
| 17110 | Destruction of skin growth, 1-14 growths | 151 | 110 | $0 |
Insurance plans in this area (ZIP 92691)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | TN | |
| Physician Assistant | TN | |
| - | TN | |
| D E R M A T O L O G Y | TN | |
| Nurse Practitioner | TN | |
| Physician Assistant | TN | |
| Physician Assistant | AR | |
| Physician Assistant | TN | |
| D E R M A T O L O G Y | TN | |
| D E R M A T O L O G Y | TN |
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