Individual provider Active NPI

Bertis Darryl Taylor III, MD

  • Student in an Organized Health Care Education/Training Program
  • Tallahassee, FL
National Provider Identifier
1063255180
Registry record updated Jun 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
1301 Hodges Dr
Tallahassee, FL 32308-4614
Phone
(850) 431-5430
NPI assigned
Jun 17, 2024
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 3, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

1301 Hodges Dr
Tallahassee, FL 32308-4614

Mailing address

1301 Hodges Dr
Tallahassee, FL 32308-4614

Other practice location 1

1264 Metropolitan Blvd
Tallahassee, FL 32312-2536
Phone (850) 383-3333

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260622003865 FL Practitioner - Family Practice 7315481413

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Florida State University College of Medicine, 2024
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1301 Hodges Dr
Tallahassee, FL 32308-4614

1301 Hodges Dr
Tallahassee, FL 32308-4676

2140 Centerville Rd
Tallahassee, FL 32308-4382

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

NPI Registry JSON

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

{
    "created_epoch": "1718582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780444800000",
    "number": "1063255180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1301 HODGES DR",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323084614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 HODGES DR",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323084614",
            "telephone_number": "850-431-5430"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1264 Metropolitan Blvd",
            "address_purpose": "LOCATION",
            "city": "Tallahassee",
            "state": "FL",
            "postal_code": "323122536",
            "country_code": "US",
            "telephone_number": "850-383-3333",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TAYLOR",
        "first_name": "BERTIS",
        "middle_name": "DARRYL",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-06-17",
        "last_updated": "2026-06-03",
        "certification_date": "2026-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tallahassee, FL

Sources for this page

Verify at the official NPI Registry.