NPIMap

Organization Active NPI

Tidalhealth Primary Care, LLC

  • Family Medicine Physician
  • Millsboro, DE
National Provider Identifier
1760201032
Registry record updated Jul 22, 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
30265 Commerce Dr Unit 206
Millsboro, DE 19966-3595
Phone
(302) 732-8400
NPI assigned
Oct 4, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2025

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

Authorized official

Name
William Pelot
Title
Chief Administrator Officer
Phone
(410) 543-7497

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

30265 Commerce Dr Unit 206
Millsboro, DE 19966-3595

Mailing address

PO Box 825474
Philadelphia, PA 19182-5474
Phone (410) 912-6989

Other names 1

  • TidalHealth Primary Care Other name

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

NPI Registry JSON

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

{
    "created_epoch": "1728000000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753142400000",
    "number": "1760201032",
    "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",
            "telephone_number": "410-912-6989",
            "fax_number": "410-912-4972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30265 COMMERCE DR UNIT 206",
            "city": "MILLSBORO",
            "state": "DE",
            "postal_code": "199663595",
            "telephone_number": "302-732-8400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDALHEALTH PRIMARY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-04",
        "last_updated": "2025-07-22",
        "certification_date": "2025-07-22",
        "status": "A",
        "authorized_official_last_name": "PELOT",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "CHIEF ADMINISTRATOR OFFICER",
        "authorized_official_telephone_number": "410-543-7497"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TidalHealth Primary Care",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "TidalHealth Primary Care",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Millsboro, DE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.