Richard Randall Thacker, D.O.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

MEOS6976 Issued in FL

Practice address

2770 Capital Medical Blvd
Ste 200
Tallahassee, FL 32308-8417

Phone

(850) 878-8235

Fax

(850) 219-2373

NPI assigned

May 23, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 6

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy, Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Hospital Physician Services of Florida PA

  • Hospitalist Physician
  • Pensacola, FL
  • NPI 1558718635

  Internal Medicine

  Medicare reassignment NPD
• Deerfield Beach Physician Services, LLC

  • Internal Medicine Physician
  • Tallahassee, FL
  • NPI 1366100364
  Medicare reassignment
• Capital Regional Healthcare

  • Internal Medicine Physician
  • Tallahassee, FL
  • NPI 1518968551
  NPD (past)

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

{
    "created_epoch": "1116806400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471651200000",
    "number": "1114920261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2770 CAPITAL MEDICAL BLVD",
            "address_2": "STE 200",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323088417",
            "telephone_number": "850-878-8235",
            "fax_number": "850-219-2373"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2770 CAPITAL MEDICAL BLVD",
            "address_2": "STE 200",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323088417",
            "telephone_number": "850-878-8235",
            "fax_number": "850-219-2373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THACKER",
        "first_name": "RICHARD",
        "middle_name": "RANDALL",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-23",
        "last_updated": "2016-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "MEOS6976",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID GROUP",
            "identifier": "058464900",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL PROVIDER BCBS",
            "identifier": "57188",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP BCBS ID NUMBER",
            "identifier": "99039",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "37822101",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00625814",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1114920261",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Testament Health Inc
• Scott A. Tetreault, M.D.
• Jacqueline Renee Tewell
• Julia Teytelbaum
• John S Thabes, M.D.
• Thomas John Thacker, DDS
• Thagard Student Health Center
• Erin Roberts Thames, ARNP
• Arasi Thangavelu, MD
• The C.a.R.E. Organization

• Internal Medicine Physician in Tallahassee, FL
• Providers in Tallahassee, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.