Douglas Tidwell, MSN, ARNP, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

9326689 Issued in FL

Practice address

5955 Rand Blvd
Sarasota, FL 34238-5160

Phone

(941) 552-7508

Fax

(941) 552-7605

NPI assigned

Oct 23, 2014

Last updated

Nov 20, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

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

Specialty

Nurse Practitioner

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Gulf Coast Pain Consultants LLCGroup PAC ID 1658516570, 37 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Empath Home Health Home health agency, Fort Myers, FL, CCN 109786
• Sarasota Memorial Hospital Hospital, Sarasota, FL, CCN 100087

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

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.

• Gulf Coast Pain Consultants LLC

  dba Clearway Pain Solutions Institute

  • Interventional Pain Medicine Physician
  • Pensacola, FL
  • NPI 1669712287
  Medicare reassignment Care Compare group NPD
• Tidwell Health Services Inc

  • Family Nurse Practitioner
  • Sarasota, FL
  • NPI 1598153652
  Authorized official Same address or phone
• Gulf Coast Pain Consultants LLC

  dba Clearway Pain Solutions Institute

  • Durable Medical Equipment & Medical Supplies
  • Fort Walton Beach, FL
  • NPI 1083455299
  NPD
• Living Well Clinic LLC

  • Clinic/Center
  • Sarasota, FL
  • NPI 1942847256
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• KB Health Solutions, LLC

  dba Empath Home Health

  • Home Health Agency
  • Fort Myers, FL
  • NPI 1659675106
  Care Compare affiliation
• Sarasota County Public Hospital District

  dba Sarasota Memorial Hospital

  • General Acute Care Hospital
  • Sarasota, FL
  • NPI 1245294826
  Care Compare affiliation

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

{
    "created_epoch": "1414022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574208000000",
    "number": "1689079337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4435 SPAHN ST",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342325135",
            "telephone_number": "941-726-2082",
            "fax_number": "941-786-0960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5955 RAND BLVD",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342385160",
            "telephone_number": "941-552-7508",
            "fax_number": "941-552-7605"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4435 Spahn St",
            "address_purpose": "LOCATION",
            "city": "Sarasota",
            "state": "FL",
            "postal_code": "342325135",
            "country_code": "US",
            "telephone_number": "941-726-2082",
            "fax_number": "941-786-0960",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TIDWELL",
        "first_name": "DOUGLAS",
        "credential": "MSN, ARNP, FNP-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-10-23",
        "last_updated": "2019-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "APRN9326689",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "9326689",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "IB924Z",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Email",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "5955 Rand Blvd",
            "city": "Sarasota",
            "state": "FL",
            "country_code": "US",
            "postal_code": "342385160",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Tidewell Hospice, Inc. (Tidewell Hospice)
• Tidewell Hospice, Inc.
• Gail M Tidmore, CRNA
• Kristine Eileen Tidswell, CRNA
• Tidwell Health Services Inc
• Karen Sue Tidwell, LMHC
• Delphine A Tierney, ARNP
• Smith Morgan Tilka, RMHCI
• Tille Eye Care & Associates, LLC
• Charles Tille, O.D.

• Family Nurse Practitioner in Sarasota, FL
• Providers in Sarasota, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.