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TIDALHEALTH PRIMARY CARE, LLC
NPI 1316809478
Family Medicine in Berlin, MD

Active since November 26, 2025CLIA 21D1015671 · Waiver
10324 OLD OCEAN CITY BLVD, BERLIN, MD 21811(410) 629-0041 Get Directions Write a Review

NPPES record last updated: November 26, 2025. Verified against the NPPES registry weekly; last sync: August 16, 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 1316809478) is a healthcare organization registered as a family medicine in Berlin, Maryland and active in the NPI registry since November 2025. The organization holds a CLIA Waiver certificate valid through August 11, 2027 and lists Sloan Trammell, Credentialing Manager, as its authorized official.

NPPES Registry Identity

NPI1316809478
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameTIDALHEALTH PRIMARY CARE, LLC
Location Address10324 OLD OCEAN CITY BLVDBerlin, MD 21811-1132
Mailing AddressPo Box 825474Philadelphia, PA 19182-5474
Phone(410) 629-0041
Organization SubpartNo
Authorized OfficialSloan TrammellCredentialing Manager · (410) 912-6989
Enumeration DateNovember 26, 2025
NPPES CertifiedNovember 26, 2025
✔ NPI 1316809478 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.
10324 OLD OCEAN CITY BLVD, Berlin, MD 21811
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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 21D1015671

Tidalhealth Primary Care · Berlin, MD
Active · expires Aug 11, 2027
CLIA Number21D1015671
Laboratory TypePhysician Office
Certificate Effective DateAugust 12, 2025
Certificate Expiration DateAugust 11, 2027
Laboratory DirectorEdwin T. Castaneda MD
Laboratory Phone(410) 629-0041
Laboratory LocationTidalhealth Primary Care10324 Old Ocean City Blvd, Berlin, MD 21811
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 4

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

EDWIN TATOY CASTANEDA M.D.
Internal Medicine
10324 OLD OCEAN CITY BLVD
BERLIN, MD 21811
Worcester County (410) 629-0041
EDWIN T. CASTANEDA, MD PA
Internal Medicine
10324 OLD OCEAN CITY BLVD
BERLIN, MD 21811
Worcester County (410) 629-0041
ATLANTIC GENERAL HOSPITAL CORPORATION
Internal Medicine
10324 OLD OCEAN CITY BLVD
BERLIN, MD 21811
Worcester County (410) 629-0041
MARY DARDEN MASON DNP, FNP-BC
Nurse Practitioner
10324 OLD OCEAN CITY BLVD
BERLIN, MD 21811
Worcester County (410) 629-0041

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 1316809478. 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 10324 Old Ocean City Blvd, Berlin, MD 21811. The listed phone number is (410) 629-0041.

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 21D1015671) is associated with this NPI, valid through August 11, 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.