NPIMap

Organization Active NPI

Tallahassee Memorial Healthcare Inc

  • Rural Health Clinic/Center
  • Crawfordville, FL
National Provider Identifier
1285683045
Registry record updated Jan 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
TALLAHASSEE MEMORIAL HEALTHCARE INC
Practice address
15 Council Moore Rd
Crawfordville, FL 32327-3117
Phone
(850) 926-7105
Fax
(850) 926-2034
NPI assigned
May 9, 2006
Last updated
Jan 9, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2025

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

Authorized official

Name
Jennifer Parks
Title
President
Phone
(850) 431-6234

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X FL Primary
Family Medicine Physician 207Q00000X

Addresses

Primary practice location

15 Council Moore Rd
Crawfordville, FL 32327-3117

Mailing address

1607 Saint James CT Ste 1
Tallahassee, FL 32308-5352
Phone (850) 431-7021

Other identifiers 3

IdentifierTypeStateIssuer
660037903MedicaidFL
24766HOtherFLBCBS GROUP #
375270406MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031222000279 FL Part B Supplier - Clinic/Group Practice 6103724778 Receives reassigned benefits from 702 practitioners
39 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tallahassee, FL; Blountstown, FL; Chipley, FL; Crawfordville, FL; Madison, FL; Marianna, FL; Monticello, FL; Panama City Beach, FL…
O20100310000505 FL Part A Provider - Rural Health Clinic 6103724778 Practice locations: Crawfordville, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285683045. Details of each certification follow.

Rural health clinic certification: CCN 103428

Legal name
TALLAHASSEE MEMORIAL HEALTHCARE INC
Doing business as
TMH PHYSICIAN PARNTERS, WAKULLA
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 15, 1998
Last certification
Sep 28, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jun 29, 1979 in FL
Enrollment address
15 Council Moore Rd
Crawfordville, FL 32327-3117
Related CCNs
100135

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 10

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

Other NPIs on the same Medicare enrollment 39

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 39

National Provider Directory

National Provider Directory

Locations (25 of 28)

602 E 5th Ave
Havana, FL 32333
Phone (850) 539-4747

200 S Orange Ave
Ste 2900
Orlando, FL 32801

651 Grand Panama Blvd
Bldg B2
Panama City Beach, FL 32407
Phone (850) 234-3087

651 Grand Panama Blvd
Ste 101
Panama City Beach, FL 32407

21 N Love St
Quincy, FL 32351
Phone (850) 566-1639

1221 Hodges Dr
Tallahassee, FL 32308

1260 Metropolitan Blvd
Fl 3
Tallahassee, FL 32312

1260 Metropolitan Blvd
Ste 302
Tallahassee, FL 32312
Phone (859) 216-0100

1300 Miccosukee Rd
Ste 504
Tallahassee, FL 32308

1304 Hodges Dr
#A
Tallahassee, FL 32308
Phone (850) 431-4500

1306 Thomasville Rd
Tallahassee, FL 32303

1309 Hodges Dr
Tallahassee, FL 32308

1401 Centerville Rd
Ste 400
Tallahassee, FL 32308
Phone (850) 431-3360

1401 Centerville Rd
Ste 5000
Tallahassee, FL 32308

1501 Surgeons Dr
Tallahassee, FL 32308

1505 Surgeons Dr
Tallahassee, FL 32308
Phone (850) 431-4325

1549 Medical Dr
Tallahassee, FL 32308

1607 Saint James Ct
Ste 1
Tallahassee, FL 32308
Phone (850) 431-7021

1607 Saint James Ct
Ste 2
Tallahassee, FL 32308
Phone (850) 878-8714

1609 Physicians Dr
Tallahassee, FL 32308
Phone (850) 431-4243

1775 One Healing Pl
Fl 2
Tallahassee, FL 32308
Phone (850) 431-5360

1776 One Healing PL
Tallahassee, FL 32308

1981 Capital Cir NE
Tallahassee, FL 32308
Phone (850) 738-7977

1981 Capital Cir NE
#2
Tallahassee, FL 32308

2633 Centennial Blvd
Tallahassee, FL 32308
Phone (850) 877-7387

Ownership & related parties

All disclosed owners & managing parties 25

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 DirectorDirector Oct 1, 2012
Warren E Jones Individual Corporate OfficerChief Communications Officer Mar 8, 2004
W-2 Managing EmployeeChief Communications Officer Mar 8, 2004
Jason Moore Individual Corporate OfficerChief Operating Officer Jul 7, 2008
W-2 Managing EmployeeChief Operating Officer Jul 7, 2008
Glenda Thornton Individual Corporate DirectorDirector Oct 1, 2006
Paula S Fortunas Individual Corporate OfficerChief Development Officer Jan 19, 2004
W-2 Managing EmployeeChief Development Officer Jan 19, 2004
Alma Littles Individual Corporate OfficerSecretary Oct 1, 2014
Corporate DirectorDirector Oct 1, 2008
Brant Copeland Individual Corporate DirectorDirector Oct 1, 2014
Donald W Lindsey Individual Corporate OfficerChief Information Officer Mar 2, 2008
W-2 Managing EmployeeChief Information Officer Mar 2, 2008
Dean Watson Individual Corporate OfficerChief Medical Officer Jan 3, 2010
W-2 Managing EmployeeChief Medical Officer Jan 3, 2010
Robert L Moore Individual Corporate OfficerChief HR Officer Apr 14, 2013
W-2 Managing EmployeeChief HR Officer Apr 14, 2013
George M Obryant Individual Corporate OfficerChief Executive Officer Jul 14, 2003
W-2 Managing EmployeeChief Executive Officer Jul 14, 2003
Andrew M Wong Individual Corporate DirectorDirector Oct 1, 2013
Cynthia Blair Individual Corporate OfficerChief Improvement Officer May 23, 2005
W-2 Managing EmployeeChief Improvement Officer May 23, 2005
Jennifer Parks Individual Corporate DirectorPresident Dec 1, 2024
W-2 Managing EmployeePresident Dec 1, 2024
Christopher S Rumana Individual Corporate DirectorDirector Oct 1, 2011
Susie Busch Transou Individual Corporate OfficerChair Elect Oct 1, 2014
Corporate DirectorDirector Oct 1, 2007
Frank Gredler Individual Corporate OfficerChair Oct 1, 2014
Corporate DirectorChair Oct 1, 2006
Lee Hinkle Individual Corporate DirectorDirector Oct 1, 2014
Rick Moore Individual Corporate DirectorDirector Oct 1, 2007
Martha W Barnett Individual Corporate DirectorDirector Oct 1, 2012
Thomas L Truman Individual Corporate DirectorDirector Oct 1, 2014
Steven L Evans Individual Corporate DirectorDirector Oct 1, 2012
Barbara E Alford Individual Corporate OfficerChief Nursing Officer Mar 10, 2013
W-2 Managing EmployeeChief Nursing Officer Mar 10, 2013
Gary E Winchester Individual Corporate DirectorDirector Oct 1, 2011
Winston Howell Individual Corporate DirectorDirector Oct 1, 2013

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

Practitioners 64

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.

View all 64

NPI Registry JSON

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

{
    "created_epoch": "1147132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736380800000",
    "number": "1285683045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1607 SAINT JAMES CT STE 1",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323085352",
            "telephone_number": "850-431-7021",
            "fax_number": "850-431-6975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 COUNCIL MOORE RD",
            "city": "CRAWFORDVILLE",
            "state": "FL",
            "postal_code": "323273117",
            "telephone_number": "850-926-7105",
            "fax_number": "850-926-2034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TALLAHASSEE MEMORIAL HEALTHCARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-09",
        "last_updated": "2025-01-09",
        "certification_date": "2025-01-09",
        "status": "A",
        "authorized_official_last_name": "PARKS",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "850-431-6234"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "FL",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "660037903",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP #",
            "identifier": "24766H",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "375270406",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Crawfordville, FL

Sources for this page

Verify at the official NPI Registry.