NPIMap

Organization Active NPI

Tallahassee Memorial Healthcare Inc

Doing business as Madison County Memorial Hospital

  • Cardiovascular Disease Physician
  • Madison, FL
National Provider Identifier
1306369657
Registry record updated Jan 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
Legal business name
TALLAHASSEE MEMORIAL HEALTHCARE INC
Doing business as
Madison County Memorial Hospital
Practice address
224 NW Crane Ave
Madison, FL 32340-1400
Phone
(850) 973-2271
Fax
(850) 973-2818
NPI assigned
Jul 19, 2017
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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X Primary

Addresses

Primary practice location

224 NW Crane Ave
Madison, FL 32340-1400

Mailing address

1300 Medical Drive
Billing Department
Tallahassee, FL 32308-4622
Phone (850) 216-0100

Other identifiers 1

IdentifierTypeStateIssuer
375270421MedicaidFL

Other names 1

  • Madison County Memorial Hospital Doing business as

Medicare participation

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

Enrollment records 1

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…

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
Tax ID family
Family Practice Progam38 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

Locations

1300 Miccosukee Rd
Ste G
Tallahassee, FL 32308
Phone (850) 431-6315

2100 Centerville Rd
Tallahassee, FL 32308
Phone (850) 216-0138

Practitioners & affiliated clinicians

Practitioners 22

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 22

NPI Registry JSON

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

{
    "created_epoch": "1500422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736380800000",
    "number": "1306369657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 MEDICAL DRIVE",
            "address_2": "BILLING DEPARTMENT",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323084622",
            "telephone_number": "850-216-0100",
            "fax_number": "850-216-0180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "224 NW CRANE AVE",
            "city": "MADISON",
            "state": "FL",
            "postal_code": "323401400",
            "telephone_number": "850-973-2271",
            "fax_number": "850-973-2818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TALLAHASSEE MEMORIAL HEALTHCARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-19",
        "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": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "375270421",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Madison County Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Madison County Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Madison, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2025; 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.

Verify at the official NPI Registry.