Tallahassee Memorial Healthcare Inc
Organization Active NPI Family Medicine Physician · Tallahassee, FL
NPI 1366293102 · NPPES record last updated May 15, 2025
Key facts
- NPI
- 1366293102
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- TALLAHASSEE MEMORIAL HEALTHCARE INC
- Practice address
- 1300 Miccosukee Rd
Tallahassee, FL 32308-5054 - Phone
- (850) 431-6200
- NPI assigned
- Mar 29, 2024
- Organization subpart
- Yes
- Parent organization (as reported)
- TALLAHASSEE MEMORIAL HEALTHCARE INC
Authorized official
- Name
- Jennifer Parks
- Title
- President
- Phone
- (850) 431-6234
Owned or controlled facilities with NPI records 1
Other NPIs on the same Medicare enrollment 40
Other NPIs with the same Medicare PAC ID 10
Member of 1
Practitioners 688
-
Philip B. McDonald, M.D.
-
Russell Gerald Gelormini, D.O.
-
Nishant Gupta, MD
-
Johnathan Charles Hays, M.D.
-
Grant Holz, MD
-
Farzaneh Kazimi, M.D.
-
Rajiv Kumar, M.D.
-
Gholamreza Malek, M.D.
-
Majid T Maybody, MD
-
Justin Hung Pham, M.D.
-
John M Pohl, MD
-
Scott E. Preusen, M.D.
-
Jason Robert Ross, M.D.
-
Amit Kumar Sanghi, D.O.
-
Arjun Sharma, M.D.
-
Michael Stone, MD
-
Tad T Tanoura, M.D.
-
Elliott Jay Wagner, M.D.
-
Jesus G Zamora, MD
-
Susan A. Gootnick, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (13 enrollments) in FL, GA, TX, MD, HI, WI, NY, IL, IN, CO, CA, SC, VA
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Tallahassee Memorial Behavior Health Center |
Hospital | Operational/Managerial Control (100%) | Jun 29, 1979 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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… |
| O20160510002584 | GA | Part B Supplier - Clinic/Group Practice | 6103724778 |
Receives reassigned benefits from 9 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Thomasville, GA |
| O20250825004230 | TX | Part B Supplier - Clinic/Group Practice | 6103724778 |
Receives reassigned benefits from 6 practitioners Practice locations: Boerne, TX; Edinburg, TX; Houston, TX; Livingston, TX; Sugar Land, TX |
| O20250825004411 | MD | Part B Supplier - Clinic/Group Practice | 6103724778 |
Receives reassigned benefits from 1 practitioner Practice locations: Ellicott City, MD |
| O20250916000856 | HI | Part B Supplier - Clinic/Group Practice | 6103724778 |
Receives reassigned benefits from 1 practitioner Practice locations: Honolulu, ID |
| O20250918003937 | WI | Part B Supplier - Clinic/Group Practice | 6103724778 |
Receives reassigned benefits from 1 practitioner Practice locations: Middleton, WI |
| O20250919001689 | NY | Part B Supplier - Clinic/Group Practice | 6103724778 |
Receives reassigned benefits from 3 practitioners Practice locations: New Hartford, NY; New York, NY; Northport, NY |
| O20251014001818 | IL | Part B Supplier - Clinic/Group Practice | 6103724778 |
Receives reassigned benefits from 1 practitioner Practice locations: Modesto, IL |
| O20251029004036 | IN | Part B Supplier - Clinic/Group Practice | 6103724778 |
Receives reassigned benefits from 1 practitioner Practice locations: Valparaiso, IN |
| O20260215000151 | CO | Part B Supplier - Clinic/Group Practice | 6103724778 |
Receives reassigned benefits from 1 practitioner Practice locations: Broomfield, CO |
| O20260220001014 | CA | Part B Supplier - Clinic/Group Practice | 6103724778 |
Receives reassigned benefits from 8 practitioners Practice locations: San Diego, CA; Rancho Palos Verdes, CA; Poway, CA; Newport Beach, CA; Irvine, CA; Kentfield, CA; Altadena, CA; Glendale, CA… |
| O20260317002481 | SC | Part B Supplier - Clinic/Group Practice | 6103724778 |
Receives reassigned benefits from 1 practitioner Practice locations: Blythewood, SC |
| O20260323002390 | VA | Part B Supplier - Clinic/Group Practice | 6103724778 |
Receives reassigned benefits from 1 practitioner Practice locations: Virginia Beach, VA |
National Provider Directory
- Part of
- Tall Mem Psychiatric G
Locations
17808 NE Charlie Johns St
Blountstown, FL 32424
Phone (850) 674-4524
651 Grand Panama Blvd
Bldg B2
Panama City Beach, FL 32407
Phone (850) 234-3087
600 Lefall Dr
Quincy, FL 32351
Phone (850) 875-3600
1304 Hodges Dr
Tallahassee, FL 32308
Phone (850) 431-4500
1505 Surgeons Dr
Tallahassee, FL 32308
Phone (850) 431-4325
1981 Capital Cir NE
Tallahassee, FL 32308
Phone (850) 738-7977
3333 Capital Oaks Dr
Tallahassee, FL 32308
Phone (850) 431-4470
2473 Care Dr
Ste 102
Tallahassee, FL 32308
Phone (850) 320-6054
1775 One Healing Pl
Fl 2
Tallahassee, FL 32308
Phone (850) 431-5360
1619 Physicians Dr
Tallahassee, FL 32308
Phone (850) 431-6800
1401 Centerville Rd
Ste 504
Tallahassee, FL 32308
Phone (850) 431-5001
1301 Hodges Dr
Tallahassee, FL 32308
Phone (850) 431-5430
1702 Riggins Rd
Ste 1
Tallahassee, FL 32308
Phone (850) 386-4602
152 Rainbow Dr
#5250
Livingston, TX 77399
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Internal Medicine Physician |
207R00000X | |||
| Cardiovascular Disease Physician |
207RC0000X | |||
| Clinical Cardiac Electrophysiology Physician |
207RC0001X | |||
| Endocrinology, Diabetes & Metabolism Physician |
207RE0101X | |||
| Pulmonary Disease Physician |
207RP1001X | |||
| Rheumatology Physician |
207RR0500X | |||
| Maternal & Fetal Medicine Physician |
207VM0101X | |||
| Gynecologic Oncology Physician |
207VX0201X | |||
| Clinical Neurophysiology Physician |
2084N0600X | |||
| Surgery Physician |
208600000X | |||
| Vascular Surgery Physician |
2086S0129X | |||
| Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician |
208G00000X | |||
| Pain Medicine Physician |
208VP0000X | |||
| Urgent Care Clinic/Center | 261QU0200X |
Addresses
Primary practice location
1300 Miccosukee Rd
Tallahassee, FL 32308-5054
Mailing address
1607 Saint James CT Ste 1
Tallahassee, FL 32308-5352
Phone (850) 431-7289
Other practice location 1
1301 Hodges Dr
Tallahassee, FL 32308-4614
Phone (850) 431-5430
Other names
- TMH Physician Partners
Other providers in Tallahassee, FL
- Tallahassee Memorial Healthcare Inc
- Tallahassee Memorial Healthcare Inc
- Tallahassee Memorial Healthcare Inc
- Tallahassee Memorial Healthcare Inc
- Tallahassee Memorial Healthcare Inc
- Tallahassee Memorial Healthcare Inc
- Tallahassee Memorial Healthcare Inc
- Tallahassee Memorial Healthcare Inc
- Tallahassee Memorial Healthcare Inc
- Tallahassee Memorial Healthcare Inc
All providers in Tallahassee, FL · Family Medicine Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 15, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.