NPIMap

Organization Active NPI

Tidalhealth Primary Care, LLC

  • Family Medicine Physician
  • Selbyville, DE
National Provider Identifier
1467315465
Registry record updated Dec 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
TIDALHEALTH PRIMARY CARE, LLC
Practice address
37464 Lion Drive
Ste 2
Selbyville, DE 19975
Phone
(302) 564-0004
NPI assigned
Dec 5, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2025

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

Authorized official

Name
Sloan Trammell
Title
Insurance Credentialing Manager
Phone
(410) 912-6989

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

37464 Lion Drive
Ste 2
Selbyville, DE 19975

Mailing address

PO Box 825474
Philadelphia, PA 19182-5474

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
08D2075943Tidalhealth Primary Care37464 Lion Dr, Unit 2, Selbyville, DE 19975Provider-performed microscopySep 8, 2027

National Provider Directory

National Provider Directory
Tax ID family
Tidalhealth Primary Care LLC23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

Organizations that report the same tax identification number in the National Provider Directory.

View all 22

Locations

37464 Lion Dr
Unit 2
Selbyville, DE 19975
Phone (302) 564-0004

NPI Registry JSON

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

{
    "created_epoch": "1764892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1764892800000",
    "number": "1467315465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 825474",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191825474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37464 LION DRIVE",
            "address_2": "STE 2",
            "city": "SELBYVILLE",
            "state": "DE",
            "postal_code": "19975",
            "telephone_number": "302-564-0004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDALHEALTH PRIMARY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-12-05",
        "last_updated": "2025-12-05",
        "certification_date": "2025-11-26",
        "status": "A",
        "authorized_official_last_name": "TRAMMELL",
        "authorized_official_first_name": "SLOAN",
        "authorized_official_title_or_position": "INSURANCE CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "410-912-6989"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Selbyville, DE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.