Active NPI
Radiology Associates of Tallahassee PA
- Diagnostic Radiology Physician
- Tallahassee, FL
National Provider Identifier
1003866773
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Diagnostic Radiology Physician
- Legal business name
- RADIOLOGY ASSOCIATES OF TALLAHASSEE PA
- Practice address
- 1600 Phillips Rd
Tallahassee, FL 32308-5304 - Phone
- (850) 878-4127
- Fax
- (850) 878-0337
- NPI assigned
- May 11, 2006
- Last updated
- Mar 14, 2014
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- John R Detelich
- Title
- Ceo
- Phone
- (850) 878-4127
Specialties & licenses 8
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Body Imaging Physician | 2085B0100X | NU | ||
| Neuroradiology Physician | 2085N0700X | NU | ||
| Nuclear Radiology Physician | 2085N0904X | NU | ||
| Pediatric Radiology Physician | 2085P0229X | NU | ||
| Diagnostic Radiology Physician | 2085R0202X | NU | Primary | |
| Vascular & Interventional Radiology Physician | 2085R0204X | NU | ||
| Diagnostic Ultrasound Physician | 2085U0001X | NU | ||
| Computed Tomography Radiologic Technologist | 2471C3401X | NU |
Addresses
Primary practice location
1600 Phillips Rd
Tallahassee, FL 32308-5304
Mailing address
PO Box 1678
Tallahassee, FL 32302-1678
Phone (850) 878-4102
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 053297505 | Medicaid | FL | |
| 300037169A | Medicaid | GA | |
| 053297500 | Medicaid | FL | |
| 00060 | Other | FL | BCBS |
| 053297501 | Medicaid | FL | |
| 053297504 | Medicaid | FL | |
| N4026 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL, TX, NY, OK, CO, WV, NE, MA, WA, DC, AZ, MI, ND, VT, MD, UT, NC, SC, GA, AL, TN
Enrollment records 21
National Provider Directory
National Provider DirectoryMember organizations 3
Organizations listed as members of this organization in the National Provider Directory.
-
- Diagnostic Radiology Physician
- Lake City, FL
- NPI 1467409631
Member Of
-
dba Radiology Associates of Tallahassee
- Diagnostic Radiology Physician
- Tallahassee, FL
- NPI 1932799814
Member Of
-
dba Tallahassee Diagnostic Imaging LTD
- Diagnostic Radiology Physician
- Tallahassee, FL
- NPI 1639129521
Member Of
Locations
12110 Business Blvd
#6328
Eagle River, AK 99577
Phone (415) 799-7060
1300 Miccosukee Rd
Tallahassee, FL 32308
Phone (850) 431-1155
1400 Village Square Blvd
#3169
Tallahassee, FL 32312
512 Nokomis Ave S
Venice, FL 34285
Phone (941) 486-3483
Practitioners & affiliated clinicians
Practitioners 107
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.
-
- Diagnostic Radiology Physician
- Bradenton, FL
- NPI 1912950635
-
- Diagnostic Radiology Physician
- Tallahassee, FL
- NPI 1629021811
-
- Student in an Organized Health Care Education/Training Program
- Tallahassee, FL
- NPI 1447638606
-
- Diagnostic Radiology Physician
- Maitland, FL
- NPI 1922018613
-
- Nurse Practitioner
- Tallahassee, FL
- NPI 1184513087
-
- Diagnostic Radiology Physician
- Pensacola, FL
- NPI 1720289200
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147305600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1394755200000",
"number": "1003866773",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1678",
"city": "TALLAHASSEE",
"state": "FL",
"postal_code": "323021678",
"telephone_number": "850-878-4102",
"fax_number": "850-942-4155"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 PHILLIPS RD",
"city": "TALLAHASSEE",
"state": "FL",
"postal_code": "323085304",
"telephone_number": "850-878-4127",
"fax_number": "850-878-0337"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "RADIOLOGY ASSOCIATES OF TALLAHASSEE PA",
"organizational_subpart": "NO",
"enumeration_date": "2006-05-11",
"last_updated": "2014-03-14",
"status": "A",
"authorized_official_last_name": "DETELICH",
"authorized_official_first_name": "JOHN",
"authorized_official_middle_name": "R",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "850-878-4127"
},
"taxonomies": [
{
"code": "2085B0100X",
"taxonomy_group": "",
"desc": "Radiology, Body Imaging",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "2085N0700X",
"taxonomy_group": "",
"desc": "Radiology, Neuroradiology",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "2085N0904X",
"taxonomy_group": "",
"desc": "Radiology, Nuclear Radiology",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "2085P0229X",
"taxonomy_group": "",
"desc": "Radiology, Pediatric Radiology",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "2085R0202X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Radiology",
"state": "NU",
"license": null,
"primary": true
},
{
"code": "2085R0204X",
"taxonomy_group": "",
"desc": "Radiology, Vascular & Interventional Radiology",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "2085U0001X",
"taxonomy_group": "",
"desc": "Radiology, Diagnostic Ultrasound",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "2471C3401X",
"taxonomy_group": "",
"desc": "Radiologic Technologist, Computed Tomography",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "053297505",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "300037169A",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "053297500",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "00060",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "053297501",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "053297504",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "N4026",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tallahassee, FL
- Brenda Rabalais, PHD
- Samantha Lane Rabon
- Bridget Shea Rader
- Natalie Ann Radford, M.D.
- Radiology Associates of Tallahassee PA
- Radiology Associates of Tallahassee PA
- Radiology Associates of Tallahassee PA
- Radiology Imaging Specialists LLC (Carefirst Imaging)
- Radiology Physician Solutions of North Florida, LLC
- Radiserv LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.