NPIMap

Organization Active NPI

Tallahassee Memorial Healthcare Inc

  • Home Health Agency
  • Tallahassee, FL
National Provider Identifier
1174539522
Registry record updated Mar 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
20480096 Issued in FL
Legal business name
TALLAHASSEE MEMORIAL HEALTHCARE INC
Practice address
1619 Physicians Dr
Tallahassee, FL 32308-4620
Phone
(850) 431-6800
Fax
(850) 431-6855
NPI assigned
Jul 31, 2006
Last updated
Mar 20, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2019

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

Authorized official

Name
Mr. Mark O'Bryant
Title
Ceo
Phone
(850) 431-5380

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 20480096 FL Primary

Addresses

Primary practice location

1619 Physicians Dr
Tallahassee, FL 32308-4620

Mailing address

1300 Miccosukee Rd
Tallahassee, FL 32308-5054
Phone (850) 431-5380

Other identifiers 1

IdentifierTypeStateIssuer
027086500MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050730000076 FL Part A Provider - Home Health Agency 6103724778 Practice locations: Tallahassee, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174539522. Details of each certification follow.

Home health agency certification: CCN 107115

Legal name
TALLAHASSEE MEMORIAL HEALTHCARE INC
Doing business as
TALLAHASSEE MEMORIAL HOME HEALTH CARE
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jul 1, 1979
Last certification
Jun 5, 2019
Ownership / control type
Non-Profit
Organization structure
CorporationNon-profit
Incorporated
Jun 27, 1979 in FL
Enrollment address
1619 Physicians Drive
Tallahassee Memorial Home Health Care
Tallahassee, FL 32308-4620
HHA Branch

Other NPIs with the same Medicare PAC ID 10

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Home health agency

Medicare Care Compare
Listed as
Tallahassee Memorial Home Health CareCCN 107115 · All quality measures
Overall star rating
3 of 5
Ownership
Non-Profit
Certified
Jul 1, 1979
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory
Tax ID family
Tallahassee Memorial Em38 organizations share this tax ID, including this one

Other organizations with this tax ID 37

Organizations that report the same tax identification number in the National Provider Directory.

View all 37

Ownership & related parties

All disclosed owners & managing parties 19

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Avery D McKnight Individual Corporate DirectorMember Oct 1, 2012
Warren E Jones Individual Corporate OfficerChief Communication Officer Mar 8, 2004
Alma Littles Individual Corporate DirectorChair Elect Oct 1, 2008
Brant Copeland Individual Corporate DirectorMember Oct 1, 2014
Robin L Moss Individual Corporate Director Apr 1, 1996 100%
W-2 Managing EmployeeExecutive Director Apr 1, 1996 100%
Donald W Lindsey Individual Corporate OfficerChief Information Officer Mar 2, 2008
Dean Watson Individual Corporate OfficerChief Medical Officer Jan 3, 2010
Amber Cranmer Individual W-2 Managing EmployeeAd; Jun 27, 2024 100%
George M Obryant Individual Corporate OfficerPresident/Ceo Jul 13, 2003
Andrew M Wong Individual Corporate DirectorMember Oct 1, 2013
Ryan Smith Individual Corporate DirectorExecutive Director of Clinical O Oct 1, 2018 100%
Christopher S Rumana Individual Corporate DirectorTreasurer Oct 1, 2011
Frank Gredler Individual Corporate DirectorMember Oct 1, 2006
Lee Hinkle Individual Corporate DirectorMember Oct 1, 2014
Priscilla Needham Individual Corporate OfficerCfo Apr 19, 2023
Martha W Barnett Individual Corporate DirectorMember Oct 1, 2012
Thomas L Truman Individual Corporate DirectorMember Oct 1, 2014
Winston Howell Individual Corporate DirectorMember Oct 1, 2013
Alberto L Fernandez Individual Corporate DirectorMember Oct 1, 2015

Owners & managing parties with NPI records 5

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Tallahassee Memorial Behavior Health CenterTallahassee, FL, CCN 10S135 Hospital Operational/Managerial Control (100%) Jun 29, 1979

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Affiliated clinicians 17

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553040000000",
    "number": "1174539522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 MICCOSUKEE RD",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323085054",
            "telephone_number": "850-431-5380",
            "fax_number": "850-431-5883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1619 PHYSICIANS DR",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323084620",
            "telephone_number": "850-431-6800",
            "fax_number": "850-431-6855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TALLAHASSEE MEMORIAL HEALTHCARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-31",
        "last_updated": "2019-03-20",
        "status": "A",
        "authorized_official_last_name": "O'BRYANT",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "850-431-5380",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "FL",
            "license": "20480096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "027086500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tallahassee, FL

Sources for this page

Verify at the official NPI Registry.