Tidalhealth Peninsula Regional, Inc.
Organization Active NPI Family Medicine Physician · Salisbury, MD
NPI 1184832040 · NPPES record last updated Feb 28, 2023
Key facts
- NPI
- 1184832040
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- TIDALHEALTH PENINSULA REGIONAL, INC.
- Practice address
- 100 E Carroll St
Peninsula Regional Medical Group
Salisbury, MD 21801-5422 - Phone
- (410) 543-7252
- Fax
- (410) 912-6386
- NPI assigned
- May 21, 2007
- Organization subpart
- No
Authorized official
- Name
- Stephanie Gary
- Title
- Cfo
- Phone
- (410) 912-6059
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 5
Practitioners 216
-
Susan C. Cottongim, RD,LDN,CDE
-
Lauren Moore, NP-C
-
Edward James Dunn, M.D.
-
Mary Beth Salmonsen, D.O.
-
Mohammad Ahmad, MBBS
-
Erin Michelle Ard, FNP
-
Anam Ashfaque, M.D.
-
Sandar Aye, MD
-
Kathryn Baker, PA-C
-
Christina M Ball, CRNP
-
Charles Anim Berko, M. D.
-
Katie Berna, FNP-C
-
Christian Dennis Bounds, M.D.
-
Jordan Pearson Braniff, FNP-C
-
Jerrold S. Canakis, M.D.
-
Jessica Karmel Cecil, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MD
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040420001571 | MD | Part B Supplier - Clinic/Group Practice | 3072509702 |
Receives reassigned benefits from 212 practitioners 2 other NPIs on this enrollment Practice locations: Salisbury, MD; Berlin, MD |
National Provider Directory
Locations
30668 Sussex Hwy
Laurel, DE 19956
Phone (302) 251-8870
35786 Atlantic Ave
Unit 3
Millville, DE 19967
Phone (302) 537-1457
630051 Box
Baltimore, MD 21263
11105 Cathage Rd
Ste 2
Berlin, MD 21811
11101 Cathage Rd
Ocean Pnes, MD 21811
Phone (410) 543-4769
145 E Carroll St
#101102
Salisbury, MD 21801
Phone (410) 912-5785
100 E Carroll St
Rm 3304
Salisbury, MD 21801
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician |
207P00000X | |||
| Family Medicine Physician |
207Q00000X | Yes | ||
| Internal Medicine Physician |
207R00000X | |||
| Endocrinology, Diabetes & Metabolism Physician |
207RE0101X | |||
| Gastroenterology Physician |
207RG0100X | |||
| Hematology & Oncology Physician |
207RH0003X | |||
| Pulmonary Disease Physician |
207RP1001X | |||
| Neurological Surgery Physician |
207T00000X | |||
| Pediatrics Physician |
208000000X | |||
| General Practice Physician |
208D00000X | |||
| Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician |
208G00000X | |||
| Adult Mental Health Clinic/Center | 261QM0850X | |||
| Adolescent and Children Mental Health Clinic/Center | 261QM0855X | |||
| Physician Assistant |
363A00000X | |||
| Family Nurse Practitioner |
363LF0000X |
Addresses
Primary practice location
100 E Carroll St
Peninsula Regional Medical Group
Salisbury, MD 21801-5422
Mailing address
100 E Carroll St
Peninsula Regional Medical Group
Salisbury, MD 21801-5422
Phone (410) 543-7252
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CC4271 | Other | MD | MEDICARE RRB |
| CA8333 | Other | MD | MEDICARE RRB |
| 0000241502 | Medicaid | DE | |
| C10607 | Other | VA | MEDICARE PTAN |
| K230 | Other | MD | MEDICARE NSC |
| K230 | Other | MD | MEDICARE PTAN |
| 401428600 | Medicaid | MD | |
| CA8334 | Other | DE | MEDICARE RRB |
| G01753 | Other | DE | MEDICARE NSC |
| 525701800 | Medicaid | MD | |
| C10607 | Other | VA | MEDICARE NSC |
| CC3716 | Other | MD | MEDICARE RRB |
| G01753 | Other | DE | MEDICARE PTAN |
Other providers in Salisbury, MD
- Melik Tiba
- Tidal Consulting & Therapy
- Tidalhealth Peninsula Regional, Inc.
- Tidalhealth Peninsula Regional, Inc.
- Tidalhealth Peninsula Regional, Inc.
- Tidalhealth Peninsula Regional, Inc.
- Tidalhealth Peninsula Regional, Inc.
- Tidalhealth Peninsula Regional, Inc.
- Tidalhealth Peninsula Regional, Inc.
- Tidalhealth Peninsula Regional, Inc.
All providers in Salisbury, MD · Family Medicine Physician in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 28, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.