Active NPI
John Scott Tidball, M.D.
- Family Medicine Physician
- California, MD
National Provider Identifier
1760580476
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- D52196
- Practice address
- 23415 Three Notch Rd
Suite 2054 Wildewood Center
California, MD 20619-4017 - Phone
- (301) 737-7833
- Fax
- (301) 737-4865
- NPI assigned
- Sep 20, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | D52196 | MD | Primary |
Addresses
Primary practice location
23415 Three Notch Rd
Suite 2054 Wildewood Center
California, MD 20619-4017
Mailing address
23415 Three Notch Rd
Suite 2054
California, MD 20619-4017
Phone (301) 737-7833
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1389505000 | Medicaid | MD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Frederick Health Hospital Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- General Acute Care Hospital
- Frederick, MD
- NPI 1538165527
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1303084800000",
"number": "1760580476",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "23415 THREE NOTCH RD",
"address_2": "SUITE 2054",
"city": "CALIFORNIA",
"state": "MD",
"postal_code": "206194017",
"telephone_number": "301-737-7833",
"fax_number": "301-737-4865"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23415 THREE NOTCH RD",
"address_2": "SUITE 2054 WILDEWOOD CENTER",
"city": "CALIFORNIA",
"state": "MD",
"postal_code": "206194017",
"telephone_number": "301-737-7833",
"fax_number": "301-737-4865"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIDBALL",
"first_name": "JOHN",
"middle_name": "SCOTT",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-20",
"last_updated": "2011-04-18",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MD",
"license": "D52196",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1389505000",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in California, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.