Individual provider Active NPI

Julianne M Tidmore, CRNA

  • Certified Registered Nurse Anesthetist
  • Pottsville, PA
National Provider Identifier
1750487575
Registry record updated Mar 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
RN268043L Issued in PA
Practice address
420 S Jackson St
Pottsville, PA 17901-3625
Phone
(570) 621-5171
Fax
(570) 621-5589
NPI assigned
Sep 16, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 13, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X RN268043L PA Primary

Addresses

Primary practice location

420 S Jackson St
Pottsville, PA 17901-3625

Mailing address

420 S Jackson St
Pottsville, PA 17901-3625
Phone (570) 621-5171

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100525000821 PA Practitioner - Certified Registered Nurse Anesthetist (Crna) 4486783792 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lehigh Valley Physician GroupGroup PAC ID 3072425123, 2,512 clinicians

Practice addresses (Care Compare)

1200 S Cedar Crest Blvd
LVPG General in Patient Pediatrics
Allentown, PA 18103-6202
Phone (610) 402-6700

Hospital & facility affiliations

  • Schuylkill Medical Center - South Jackson Street Hospital, Pottsville, PA, CCN 390030
  • Lehigh Valley Hospital Hospital, Allentown, PA, CCN 390133

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Lehigh Valley Anesthesia Services, P. C. Nurse Anesthetist, Certified Registered CurrentSince Mar 13, 2017 Accepting new patients
Lehigh Valley Physician Group Current Accepting new patients
Lehigh Valley Physician Group CurrentSince Dec 30, 2023 Accepting new patients
Lehigh Valley Physician Group CurrentSince Dec 30, 2023 Accepting new patients

Locations

2100 Mack Blvd
Allentown, PA 18103
Phone (484) 224-1892

1200 S Cedar Crest Blvd
Allentown, PA 18103
Phone (484) 862-3200

2310 Highland Ave
Bethlehem, PA 18020
Phone (610) 691-4300

5649 Wynnewood Dr
Ste 104
Laurys Station, PA 18059
Phone (610) 262-6641

420 S Jackson St
Pottsville, PA 17901
Phone (570) 621-5000

700 E Norwegian St
Pottsville, PA 17901
Phone (570) 621-4000

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 7

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": "1158364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426204800000",
    "number": "1750487575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 S JACKSON ST",
            "city": "POTTSVILLE",
            "state": "PA",
            "postal_code": "179013625",
            "telephone_number": "570-621-5171",
            "fax_number": "570-621-5589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 S JACKSON ST",
            "city": "POTTSVILLE",
            "state": "PA",
            "postal_code": "179013625",
            "telephone_number": "570-621-5171",
            "fax_number": "570-621-5589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIDMORE",
        "first_name": "JULIANNE",
        "middle_name": "M",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-16",
        "last_updated": "2015-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "PA",
            "license": "RN268043L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pottsville, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.