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TIDALHEALTH PRIMARY CARE, LLC
NPI 1053273110
Family Medicine in Snow Hill, MD

Active since November 26, 2025CLIA 21D2322432 · Waiver
6040 PUBLIC LANDING RD, SNOW HILL, MD 21863(410) 629-6580 Get Directions Write a Review

NPPES record last updated: November 26, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Tidalhealth Primary Care, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TIDALHEALTH PRIMARY CARE, LLC (NPI 1053273110) is a healthcare organization registered as a family medicine in Snow Hill, Maryland and active in the NPI registry since November 2025. The organization holds a CLIA Waiver certificate valid through April 21, 2027 and lists Sloan Trammell, Credentialing Mananger, as its authorized official.

NPPES Registry Identity

NPI1053273110
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameTIDALHEALTH PRIMARY CARE, LLC
Location Address6040 PUBLIC LANDING RDSnow Hill, MD 21863-2453
Mailing AddressPo Box 825474Philadelphia, PA 19182-5474
Phone(410) 629-6580
Organization SubpartNo
Authorized OfficialSloan TrammellCredentialing Mananger · (410) 912-6989
Enumeration DateNovember 26, 2025
NPPES CertifiedNovember 26, 2025
✔ NPI 1053273110 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
6040 PUBLIC LANDING RD, Snow Hill, MD 21863
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 21D2322432

Tidalhealth Primary Care · Snow Hill, MD
Active · expires Apr 21, 2027
CLIA Number21D2322432
Laboratory TypePhysician Office
Certificate Effective DateApril 22, 2025
Certificate Expiration DateApril 21, 2027
Laboratory DirectorEdwin Castaneda
Laboratory Phone(410) 641-9362
Laboratory LocationTidalhealth Primary Care6040 Public Landing Rd Rm 14, Snow Hill, MD 21863
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

BRANDI SIERRA RUSH
Registered Nurse
6040 PUBLIC LANDING RD
SNOW HILL, MD 21863
Worcester County (410) 632-1100
ATLANTIC GENERAL HOSPITAL CORPORATION
Nurse Practitioner (Family)
6040 PUBLIC LANDING RD
SNOW HILL, MD 21863
Worcester County (410) 629-0041
JARYN E. ZAMPELLI
Case Manager/Care Coordinator
6040 PUBLIC LANDING RD
SNOW HILL, MD 21863
Worcester County (410) 632-1100
WORCESTER COUNTY HEALTH DEPARTMENT
Community/Behavioral Health
6040 PUBLIC LANDING RD
SNOW HILL, MD 21863
Worcester County (410) 632-1100
WORCESTER COUNTY HEALTH DEPARTMENT
Public Health or Welfare
6040 PUBLIC LANDING RD
SNOW HILL, MD 21863
Worcester County (410) 632-1100
WORCESTER COUNTY HEALTH DEPARTMENT
Case Management
6040 PUBLIC LANDING RD
SNOW HILL, MD 21863
Worcester County (410) 632-1100
GABRIELLE MARIA SHIELDS
Counselor (Professional)
6040 PUBLIC LANDING RD
SNOW HILL, MD 21863
Worcester County (410) 632-1100
KATRINA R. STEPHANOS CRNP-FAMILY
Nurse Practitioner (Family)
6040 PUBLIC LANDING RD
SNOW HILL, MD 21863
Worcester County (410) 632-1100

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Tidalhealth Primary Care, LLC's NPI number?

The NPI number for Tidalhealth Primary Care, LLC is 1053273110. It was assigned to this organization in the NPPES registry on November 26, 2025.

Where is Tidalhealth Primary Care, LLC located?

Tidalhealth Primary Care, LLC is located at 6040 Public Landing Rd, Snow Hill, MD 21863. The listed phone number is (410) 629-6580.

What is Tidalhealth Primary Care, LLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Tidalhealth Primary Care, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 21D2322432) is associated with this NPI, valid through April 21, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Tidalhealth Primary Care, LLC was last updated on November 26, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.