NPIMap

Organization Active NPI

Tidalhealth Peninsula Regional, Inc.

  • General Acute Care Hospital
  • Salisbury, MD
National Provider Identifier
1780689463
Registry record updated Oct 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
22003 Issued in MD
Legal business name
TIDALHEALTH PENINSULA REGIONAL, INC.
Practice address
100 E Carroll St
Salisbury, MD 21801-5422
Phone
(410) 546-6400
Fax
(410) 543-7020
NPI assigned
Jun 17, 2005
Last updated
Oct 23, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2020

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

Authorized official

Name
Steven Leonard
Title
President/C.E.O.
Phone
(410) 546-6400

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 22003 MD Primary
Clinical Medical Laboratory 291U00000X 22003 MD

Addresses

Primary practice location

100 E Carroll St
Salisbury, MD 21801-5422

Mailing address

100 E Carroll St
Salisbury, MD 21801-5422
Phone (410) 546-6400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040420001571 MD Part B Supplier - Clinic/Group Practice 3072509702 Receives reassigned benefits from 212 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Salisbury, MD; Berlin, MD
O20080527000410 MD Part A Provider - Hospital 3072509702 Practice locations: Salisbury, MD; Snow Hill, MD; Princess Anne, MD; Crisfield, MD; Berlin, MD; Cambridge, MD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1780689463. Details of each certification follow.

Hospital certification: CCN 210019

Legal name
TIDALHEALTH PENINSULA REGIONAL INC
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Aug 11, 2012
Beds
362
Ownership / control type
Private (not for profit)
Organization structure
OtherNon-profit
Incorporated
Jun 10, 1897 in MD
Enrollment address
100 E Carroll St
Salisbury, MD 21801-5422
Other Hospital Practice Location
Hospital subgroups
Acute care

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Tidalhealth Peninsula Regional, IncCCN 210019 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

30549 Sussex Hwy
Laurel, DE 19956
Phone (302) 715-5214

11101 Cathage Rd
Ste 1
Berlin, MD 21811
Phone (410) 912-6106

11105 Cathage Rd
Ste 2
Berlin, MD 21811

9950 N Main St
Berlin, MD 21811
Phone (410) 912-6710

106 Milford St
Ste 404
Salisbury, MD 21804
Phone (410) 543-7294

Ownership & related parties

All disclosed owners & managing parties 26

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Maria Geary Lehman Individual Corporate Director Jan 1, 2020
Mary Christine Dibartolo Individual Corporate Director Jan 1, 2020
Michelle Procino-Wells Individual Corporate Director Jan 1, 2020
Janelle Marie Beiler Individual Corporate Director Jan 1, 2020
Karen Poisker Individual Corporate Director Jan 1, 2020
Ryan McLaughlin Individual Corporate DirectorMember, Board of Trustees Oct 1, 2013
Steven Leonard Individual Corporate OfficerPresident/Ceo Jan 4, 2018
Timothy L Benning Individual Corporate DirectorMember Board of Trustees Nov 1, 2013
David Rommel Individual Corporate DirectorMember, Board of Trustees Nov 1, 2013
Mehmet Diriker Individual Corporate Director Oct 31, 2017
Montgomery Saylor Individual Corporate DirectorVice Chairman, Board of Trustees Jan 1, 2007
Julius D Zant Individual Corporate DirectorMember, Board of Trustees Nov 1, 2017
Martin Neat Individual Corporate DirectorMember, Board of Trustees Jan 1, 2007
Deborah Abbott Individual Corporate Director Jan 1, 2012
Monica Warsaw Individual W-2 Managing Employee Jul 1, 2021
Andrea Williams Individual Corporate Officer Oct 31, 2018
Benny Stover Individual Corporate OfficerSr VP Finance/Cfo Jan 2, 2026
Herbert Geary Individual Corporate DirectorMember, Board of Trustees Jan 1, 2012
Mark Thomas Edney Individual Corporate Director Jan 1, 2020
Thomas J Riccio Individual Corporate DirectorMember, Board of Trustees Jan 1, 2012
Rondall E Allen Individual Corporate Director Jan 1, 2020
Vel Natesan Individual Corporate DirectorMember Board of Directors Oct 31, 2017
Thomas Coates Individual Corporate DirectorMember, Board of Trustees Jan 1, 2012
Susan Wilgus Murphy Individual Corporate Director Jan 1, 2020
Simona C Eng Individual Corporate DirectorMember Board of Trustees Oct 31, 2017
James Webster Hartstein Individual Corporate Director Jan 1, 2020

Owners & managing parties with NPI records 5

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 100

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 100

Affiliated clinicians 935

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 935

NPI Registry JSON

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

{
    "created_epoch": "1118966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603411200000",
    "number": "1780689463",
    "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": "410-546-6400",
            "fax_number": "410-543-7020"
        },
        {
            "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",
            "fax_number": "410-543-7020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDALHEALTH PENINSULA REGIONAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-17",
        "last_updated": "2020-10-23",
        "certification_date": "2020-10-23",
        "status": "A",
        "authorized_official_last_name": "LEONARD",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_title_or_position": "PRESIDENT/C.E.O.",
        "authorized_official_telephone_number": "410-546-6400"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "MD",
            "license": "22003",
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "MD",
            "license": "22003",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salisbury, MD

Sources for this page

Verify at the official NPI Registry.