DR. JONATHAN D TIDWELL (MD) – Anesthesiology Physician, NPI 1053574939

DR. JONATHAN D TIDWELL (MD) is a healthcare provider. based in Niceville, Florida. specializing in ANESTHESIOLOGY. They hold the professional credentials MD. They hold a License No. 061763 (GA). The NPI Number for DR. JONATHAN D TIDWELL (MD) is 1053574939

Main info

Male
Sole Proprietor
19 Years Of Experience
Accepts Medicare Assignment
Name
DR. JONATHAN D TIDWELL (MD)
NPI
1053574939
Phone
(813) 482-6956
Address
2337 CANAL DR
Enumeration Date
9 July 2008
Last Update Date
19 November 2013

Doctor Profile

Medical School Name
UNIVERSITY OF SOUTH FLORIDA COLLEGE OF MEDICINE
Secondary Phone
8888514642
Graduation Year
2007 (19 years ago)
PAC ID
5991925729
Group Practice PAC ID
3779832530
Professional Enrollment ID
I20140930001030
Address ID
FL324356307DE4413XSXXX500
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience67
Completeness75
Years active:17State licenses:2Digital endpointsOther names

3,340 ANESTHESIOLOGY in FL

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Provider Addresses for DR. JONATHAN D TIDWELL (MD)

  • 2337, Canal Drive, Niceville, Okaloosa County, Florida, 32578, United States

    NICEVILLE, FL 325782911

    Phone: (813) 482-6956

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 1 Open Payments records for all available years, with a total value of $22.

Total Amount is formed as General ($22) + Research ($0) + Ownership ($0) = $22.

Last reported payment date: 2024-10-10 • Largest payer in this snapshot: Merck Sharp & Dohme LLC ($22).

Total Amount

$22

General + Research + Ownership

Payments

1

Total payment records

General Amount

$22

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-10-10

Latest reported date

Top Companies

Largest payers in this snapshot

CompanyAmount
Merck Sharp & Dohme LLC$22
View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2021-09-28

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking 2 Medicare enrollment records; no due dates published yet.

Enrollment records

2

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20140930001030IAnesthesiologyFLTBD
I20210928000779IAnesthesiologyALTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 32578)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 3779832530View full group profile
NameSpecialtyState
Certified Registered Nurse Anesthetist (Crna)FL
Interventional Pain Management, AnesthesiologyMI
A N E S T H E S I O L O G YGA
Certified Registered Nurse Anesthetist (Crna)MA
Certified Registered Nurse Anesthetist (Crna)FL
Certified Registered Nurse Anesthetist (Crna)NY
Anesthesiology, Interventional Pain ManagementFL
Certified Registered Nurse Anesthetist (Crna)TX
Certified Registered Nurse Anesthetist (Crna)MA
Certified Registered Nurse Anesthetist (Crna)NC

Reviews

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Frequently asked questions

What is the standard ID for DR. JONATHAN D TIDWELL (MD) in the U.S.?
In the U.S., DR. JONATHAN D TIDWELL (MD) is identified by NPI 1053574939.
Does the public listing show DR. JONATHAN D TIDWELL (MD) as active?
DR. JONATHAN D TIDWELL (MD)'s NPI record reflects an active status in NPPES.
What does the directory say DR. JONATHAN D TIDWELL (MD) does?
Insurance directories may phrase it differently, but here DR. JONATHAN D TIDWELL (MD) maps to Anesthesiology Physician. Clinical services aligned with this taxonomy classification.
Which community is linked to DR. JONATHAN D TIDWELL (MD)?
DR. JONATHAN D TIDWELL (MD) shows a connection to Niceville, Florida in registry-derived data.
Can I export DR. JONATHAN D TIDWELL (MD)'s record?
You can download the official NPPES record; we summarize key fields for readability.

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