NPIMap

Organization Active NPI

Tidalhealth Peninsula Regional, Inc.

  • Health Service Clinic/Center
  • Salisbury, MD
National Provider Identifier
1982171005
Registry record updated Oct 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
Legal business name
TIDALHEALTH PENINSULA REGIONAL, INC.
Practice address
106 Milford St Ste 404
Salisbury, MD 21804-6967
Phone
(410) 543-7294
NPI assigned
Oct 26, 2018
Last updated
Oct 26, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2020

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

Authorized official

Name
Mrs. Mickey Griffin
Title
Director of Patient Financial Serv
Phone
(410) 543-7437

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X Primary
General Acute Care Hospital 282N00000X

Addresses

Primary practice location

106 Milford St Ste 404
Salisbury, MD 21804-6967

Mailing address

100 E Carroll St
Salisbury, MD 21801-5422
Phone (410) 543-7437

Other practice location 1

1336 Belmont Ave Ste 501A
Salisbury, MD 21804-4500
Phone (410) 543-7475

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190304002150 MD Part B Supplier - Hospital Department(S) 3072509702 Receives reassigned benefits from 1 practitioner
Practice locations: Salisbury, MD

Other NPIs with the same Medicare PAC ID 5

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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
21D2259406Tidalhealth Peninsula Regional Inc Richard a Henso106 Milford Street Suite 603, Salisbury, MD 21804Certificate of waiverMay 4, 2028

National Provider Directory

National Provider Directory
Tax ID family
PRMC Family Internal33 organizations share this tax ID, including this one

Other organizations with this tax ID 32

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

View all 32

Locations

1336 Belmont Ave
Ste 501A
Salisbury, MD 21804
Phone (410) 543-7475

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1540512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603670400000",
    "number": "1982171005",
    "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": "410-543-7437",
            "fax_number": "410-543-7020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 MILFORD ST STE 404",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218046967",
            "telephone_number": "410-543-7294"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1336 Belmont Ave Ste 501A",
            "address_purpose": "LOCATION",
            "city": "Salisbury",
            "state": "MD",
            "postal_code": "218044500",
            "country_code": "US",
            "telephone_number": "410-543-7475",
            "fax_number": "410-543-7478",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TIDALHEALTH PENINSULA REGIONAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-26",
        "last_updated": "2020-10-26",
        "certification_date": "2020-10-26",
        "status": "A",
        "authorized_official_last_name": "GRIFFIN",
        "authorized_official_first_name": "MICKEY",
        "authorized_official_title_or_position": "DIRECTOR OF PATIENT FINANCIAL SERV",
        "authorized_official_telephone_number": "410-543-7437",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salisbury, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2020; 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.