Individual provider Active NPI

Saida Mouotassim Elidrissi

  • Acute Care Nurse Practitioner
  • Newark, DE
National Provider Identifier
1356230494
Registry record updated Oct 1, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
LP-0010864 Issued in DE
Practice address
4755 Ogletown Stanton Rd Ste 5A43
Newark, DE 19718-2200
Phone
(302) 623-0188
Fax
(302) 733-5640
NPI assigned
Jul 2, 2025
Last updated
Oct 1, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 1, 2025

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X LP-0010864 DE
Gerontology Nurse Practitioner 363LG0600X LP-0010864 DE
Registered Nurse 163W00000X L1-0067141 DE
Acute Care Nurse Practitioner 363LA2100X LP-0010864 DE Primary
Nurse Practitioner 363L00000X LP-0010864 DE

Addresses

Primary practice location

4755 Ogletown Stanton Rd Ste 5A43
Newark, DE 19718-2200

Mailing address

41 Montague Rd
Newark, DE 19713-1153
Phone (302) 528-6776

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
I20251015002325 DE Practitioner - Nurse Practitioner 0547757353 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Christiana Care Health Services IncGroup PAC ID 9739097569, 1,480 clinicians

Practice addresses (Care Compare)

4755 Ogletown Stanton Rd
Newark, DE 19718-2200
Phone (302) 623-0188

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
L1-0067141DEMDRegistered Nurse
LP-0010864DEMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Christiana Care Health Services Inc CurrentSince Oct 1, 2025 Accepting new patients
Christiana Care Health Services Inc CurrentSince Oct 1, 2025 Accepting new patients

Locations

4755 Ogletown Stanton Rd
Newark, DE 19718
Phone (302) 733-1700

4755 Ogletown Stanton Rd
Ste 5A43
Newark, DE 19718
Phone (302) 623-0188

1401 Foulk Rd
Ste 100B
Wilmington, DE 19803
Phone (302) 320-9440

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1751414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759276800000",
    "number": "1356230494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 MONTAGUE RD",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197131153",
            "telephone_number": "302-528-6776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4755 OGLETOWN STANTON RD STE 5A43",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197182200",
            "telephone_number": "302-623-0188",
            "fax_number": "302-733-5640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOUOTASSIM ELIDRISSI",
        "first_name": "SAIDA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-07-02",
        "last_updated": "2025-10-01",
        "certification_date": "2025-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "DE",
            "license": "LP-0010864",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "DE",
            "license": "LP-0010864",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "DE",
            "license": "L1-0067141",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "DE",
            "license": "LP-0010864",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "DE",
            "license": "LP-0010864",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newark, DE

Sources for this page

Verify at the official NPI Registry.