Tidalhealth Physician Network, Inc.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

TIDALHEALTH PHYSICIAN NETWORK, INC.

Practice address

3304 Hayman Dr
Federalsburg, MD 21632-2626

Phone

(410) 754-2400

NPI assigned

Jan 30, 2025

Last updated

Jul 22, 2025By the provider in NPPES

Organization subpart

No

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

Addresses

Other names 1

• TidalHealth Federalsburg Other name

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Tidalhealth Physician Network Inc17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

Organizations that report the same tax identification number in the National Provider Directory.

• Tidalhealth Physician Network, Inc.

  • Oncology Clinic/Center
  • Berlin, MD
  • NPI 1811732514
  NPD tax ID
• Tidalhealth Nanticoke, Inc

  • Anesthesiology Physician
  • Seaford, DE
  • NPI 1134956394
  NPD tax ID
• Tidalhealth Physician Network, Inc.

  • Family Medicine Physician
  • Seaford, DE
  • NPI 1063225365
  NPD tax ID
• Tidalhealth Physician Network, Inc.

  • Gastroenterology Physician
  • Seaford, DE
  • NPI 1063377679
  NPD tax ID
• Tidalhealth Physician Network, Inc.

  • Nurse Practitioner
  • Seaford, DE
  • NPI 1114712692
  NPD tax ID
• Tidalhealth Physician Network, Inc.

  • Family Medicine Physician
  • Delmar, DE
  • NPI 1154134484
  NPD tax ID
• Tidalhealth Physician Network, Inc.

  • Family Medicine Physician
  • Laurel, DE
  • NPI 1205649514
  NPD tax ID
• Tidalhealth Physician Network, Inc.

  • Surgery Physician
  • Seaford, DE
  • NPI 1396558623
  NPD tax ID
• Tidalhealth Physician Network, Inc.

  • Family Medicine Physician
  • Georgetown, DE
  • NPI 1437962768
  NPD tax ID
• Tidalhealth Physician Network, Inc.

  • Internal Medicine Physician
  • Lewes, DE
  • NPI 1467277863
  NPD tax ID
• Tidalhealth Physician Network, Inc.

  • Medical Oncology Physician
  • Seaford, DE
  • NPI 1538972849
  NPD tax ID
• Tidalhealth Physician Network, Inc.

  • Family Medicine Physician
  • Bridgeville, DE
  • NPI 1639982952
  NPD tax ID

Practitioners 1

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.

• Tiarra Jones-Bbosa, CRNP

  • Family Nurse Practitioner
  • Federalsburg, MD
  • NPI 1497443014
  NPD (past)

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

{
    "created_epoch": "1738195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753142400000",
    "number": "1871306191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 824327",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191824327",
            "telephone_number": "410-912-6989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3304 HAYMAN DR",
            "city": "FEDERALSBURG",
            "state": "MD",
            "postal_code": "216322626",
            "telephone_number": "410-754-2400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIDALHEALTH PHYSICIAN NETWORK, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-30",
        "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 Federalsburg",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "TidalHealth Federalsburg",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Amanda Priestley
• Paul Matthew Reinbold, M.D.
• Roslyn Roxanne Robinson-Kellum, DDS
• Reeva Sawhney, DMD
• John P Sloan, DDS
• Adrienne L Webb, DDS
• Randi Marie Welch, LGADC
• Christopher Denton Willis Sr., CNA, GNA, CLA, CMA
• Courtney Leeann Wise, PRS

• Family Medicine Physician in Federalsburg, MD
• Providers in Federalsburg, MD by specialty
• Family Medicine Physician in Maryland

• 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.
• 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.