Individual provider Active NPI

Jeannette Anna Daum, CRNP

  • Acute Care Nurse Practitioner
  • Salisbury, MD
National Provider Identifier
1548772577
Registry record updated Jan 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
R220574 Issued in MD
Practice address
100 E Carroll St
Salisbury, MD 21801-5422
Phone
(410) 546-6400
NPI assigned
Oct 31, 2017
Last updated
Jan 12, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X R220574 MD Primary

Addresses

Primary practice location

100 E Carroll St
Salisbury, MD 21801-5422

Mailing address

100 E Carroll St
Salisbury, MD 21801-5422
Phone (410) 543-7722

Other names 1

  • Jeannette Anna Crossan Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DE2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20180104000125 MD Practitioner - Nurse Practitioner 6406114099 Reassigns benefits to 2 organizations
I20220309001236 DE Practitioner - Nurse Practitioner 6406114099 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2017
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
Tidalhealth Pulmonary
Salisbury, MD 21801-5422
Phone (410) 543-7722

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R220574MDMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Tidalhealth Peninsula Regional, Inc. CurrentSince Dec 11, 2017 Accepting new patients
Tidalhealth Physician Network, Inc. CurrentSince Dec 7, 2021 Accepting new patients
Tidalhealth Specialty Care, LLC CurrentSince Sep 1, 2020 Accepting new patients
Tidalhealth Peninsula Regional, Inc. CurrentSince Dec 11, 2017 Accepting new patients
Tidalhealth Specialty Care, LLC Past Accepting new patients

Locations

801 Middleford Rd
Seaford, DE 19973
Phone (302) 628-9178

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

106 Milford St
Ste 201
Salisbury, MD 21804
Phone (410) 543-1616

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

Organizations & group practices 5

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 3

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": "1509408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705017600000",
    "number": "1548772577",
    "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": "410-543-7722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E CARROLL ST",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218015422",
            "telephone_number": "410-546-6400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAUM",
        "first_name": "JEANNETTE",
        "middle_name": "ANNA",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-10-31",
        "last_updated": "2024-01-12",
        "certification_date": "2024-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MD",
            "license": "R220574",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JEANNETTE",
            "last_name": "CROSSAN",
            "middle_name": "ANNA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Salisbury, MD

Sources for this page

Verify at the official NPI Registry.