MARY TISDALE (CNM) – Advanced Practice Midwife, NPI 1992034532
Advanced Practice Midwife
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for MARY TISDALE (CNM)
1025 S 6TH ST
SPRINGFIELD, IL 627032403
Phone: (217) 528-7541
Fax: (772) 879-0436
Type: Mailing
1001 MAIN ST STE 300
PEORIA, IL 616062036
Phone: (309) 495-0200
Fax: (309) 676-6545
Type: Location
Northwest Lake Whitney Place, Port St. Lucie, St. Lucie County, Florida, 34986, United States
PORT ST LUCIE, FL 349861615
Phone: (772) 785-8000
Fax: (772) 879-0436
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 7 Open Payments records for all available years, with a total value of $135.
Total Amount is formed as General ($135) + Research ($0) + Ownership ($0) = $135.
Last reported payment date: 2024-11-11 • Largest payer in this snapshot: Myriad Genetic Laboratories, Inc. ($41).
Total Amount
$135
General + Research + Ownership
Payments
7
Total payment records
General Amount
$135
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-11
Latest reported date
Top Companies
Largest payers in this snapshot
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: 2012-01-18
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 |
|---|---|---|---|---|
| I20120118000197 | I | Certified Nurse Midwife (Cnm) | IL | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 62703)
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