Individual provider Active NPI

Alexandra Mae McDermott

  • Family Nurse Practitioner
  • Millsboro, DE
National Provider Identifier
1023770963
Registry record updated Apr 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
LG-0011885 Issued in DE
Practice address
30265 Commerce Dr Unit 206
Millsboro, DE 19966-3595
Phone
(302) 732-8400
NPI assigned
Oct 7, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 8, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X LG-0011885 DE Primary

Addresses

Primary practice location

30265 Commerce Dr Unit 206
Millsboro, DE 19966-3595

Mailing address

100 E Carroll St
Salisbury, MD 21801-5422
Phone (410) 546-6400

Other practice location 1

420 E North Pointe Dr Apt 455
Salisbury, MD 21804-2354
Phone (717) 497-0089

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220425000730 DE Practitioner - Nurse Practitioner 7416344346 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tidalhealth Primary Care LLCGroup PAC ID 7911320635, 63 clinicians

Practice addresses (Care Compare)

30265 Commerce Dr
Unit 206
Millsboro, DE 19966-3595
Phone (302) 732-8400

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
LG-0011885DEMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Tidalhealth Primary Care, LLC CurrentSince Apr 1, 2022 Accepting new patients

Locations

30668 Sussex Hwy
Laurel, DE 19956
Phone (302) 251-8870

30265 Commerce Dr
Unit 103
Millsboro, DE 19966
Phone (302) 297-2598

30265 Commerce Dr
Millsboro, DE 19966
Phone (302) 629-5050

30265 Commerce Dr
Unit 206
Millsboro, DE 19966
Phone (302) 732-8400

100 E Carroll St
Salisbury, MD 21801
Phone (410) 543-7100

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1633564800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649376000000",
    "number": "1023770963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E CARROLL ST",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218015422",
            "telephone_number": "410-546-6400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30265 COMMERCE DR UNIT 206",
            "city": "MILLSBORO",
            "state": "DE",
            "postal_code": "199663595",
            "telephone_number": "302-732-8400"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "420 E North Pointe Dr Apt 455",
            "address_purpose": "LOCATION",
            "city": "Salisbury",
            "state": "MD",
            "postal_code": "218042354",
            "country_code": "US",
            "telephone_number": "717-497-0089",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCDERMOTT",
        "first_name": "ALEXANDRA",
        "middle_name": "MAE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-10-07",
        "last_updated": "2022-04-08",
        "certification_date": "2022-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "DE",
            "license": "LG-0011885",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Millsboro, DE

Sources for this page

Verify at the official NPI Registry.