Individual provider Active NPI

Nidia Guadalupe Hall, CRNP

  • Family Nurse Practitioner
  • Salisbury, MD
National Provider Identifier
1083308951
Registry record updated Jun 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R229786 Issued in MD
Practice address
2425 N Salisbury Blvd
Salisbury, MD 21801-2138
Phone
(847) 719-6075
NPI assigned
Jun 5, 2023
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 5, 2023

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 R229786 MD Primary

Addresses

Primary practice location

2425 N Salisbury Blvd
Salisbury, MD 21801-2138

Mailing address

6070 Tarry Town Rd
Salisbury, MD 21801-2506
Phone (443) 513-1357

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
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
I20240208000946 MD Practitioner - Nurse Practitioner 7315380151 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Tidalhealth Specialty Care LLCGroup PAC ID 7113340845, 375 clinicians

Practice addresses (Care Compare)

100 E Carroll St
Salisbury, MD 21801-5422

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Tidalhealth Specialty Care, LLC CurrentSince Jan 15, 2024 Accepting new patients
Tidalhealth Specialty Care, LLC Past Accepting new patients

Locations

11101 Cathage Rd
Ocean Pnes, MD 21811
Phone (410) 543-4769

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

Organizations & group practices 2

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 4

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": "1685923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685923200000",
    "number": "1083308951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6070 TARRY TOWN RD",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218012506",
            "telephone_number": "443-513-1357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2425 N SALISBURY BLVD",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218012138",
            "telephone_number": "847-719-6075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALL",
        "first_name": "NIDIA",
        "middle_name": "GUADALUPE",
        "credential": "CRNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-06-05",
        "last_updated": "2023-06-05",
        "certification_date": "2023-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R229786",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salisbury, MD

Sources for this page

Verify at the official NPI Registry.