DR. HOLLIS TIDMORE (MD) – Surgery Physician, NPI 1962473975
Surgery Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
787 GENERAL SURGERY in MO
Provider Addresses for DR. HOLLIS TIDMORE (MD)
1422 S SAM HOUSTON BLVD
HOUSTON, MO 654832130
Phone: (417) 967-1252
Fax: (417) 967-0417
Type: Mailing
1333 S SAM HOUSTON BLVD STE C
HOUSTON, MO 654832046
Phone: (417) 967-1252
Fax: (417) 967-0417
Type: Mailing
1226, Linn Street, Sikeston, Scott County, Missouri, 63801, United States
SUITE B
SIKESTON, MO 638015200
Phone: (573) 475-8599
Fax: (573) 475-8596
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 3 Open Payments records for all available years, with a total value of $79.
Total Amount is formed as General ($79) + Research ($0) + Ownership ($0) = $79.
Last reported payment date: 2024-05-02 • Largest payer in this snapshot: Olympus America Inc. ($36).
Total Amount
$79
General + Research + Ownership
Payments
3
Total payment records
General Amount
$79
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-05-02
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Olympus America Inc. | $36 |
| Novo Nordisk Inc | $24 |
| Boston Scientific Corporation | $19 |
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: 2009-05-11
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2023-08-31 (1015 days ago).
Enrollment records
1
Earliest due date
2023-08-31
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 |
|---|---|---|---|---|
| I20090511000085 | I | General Surgery | MO | 2023-08-31 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
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 |
|---|---|---|---|---|
| 99204 | New patient office or other outpatient visit, 45-59 minutes | 70 | 70 | $0 |
| 99231 | Subsequent hospital care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes | 47 | 16 | $0 |
| 45380 | Biopsy of large bowel using a flexible endoscope | 45 | 45 | $0 |
| 43239 | Biopsy of esophagus, stomach, and/or upper small bowel using a flexible endoscope | 32 | 31 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 21 | 20 | $0 |
Insurance plans in this area (ZIP 65483)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| GENERAL PRACTICE | MO | 36556 | Insertion of central venous catheter for infusion, patient 5 years or older | 24 | 21 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | MO | |
| Nurse Practitioner | MO | |
| Nurse Practitioner | MO | |
| Physician Assistant | MO | |
| O B S T E T R I C S/ G Y N E C O L O G Y | MO | |
| - | MO | |
| General Surgery | MO | |
| Family Practice | MO | |
| - | MO | |
| Family Practice | SD |
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