NPIMap

Organization Active NPI

Tallahassee Memorial Healthcare Inc

  • Internal Medicine Physician
  • Tallahassee, FL
National Provider Identifier
1386862852
Registry record updated Jan 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
TALLAHASSEE MEMORIAL HEALTHCARE INC
Practice address
1505 Surgeons Drive
Tallahassee, FL 32308
Phone
(850) 431-4325
Fax
(850) 431-3533
NPI assigned
Apr 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2019

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

Authorized official

Name
Mr. Robin L. Moss
Title
Executive Director
Phone
(850) 431-6256

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

1505 Surgeons Drive
Tallahassee, FL 32308

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
24766AOtherFLBCBS GROUP #

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2172582Tallahassee Memorial Healthcare1505 Surgeons Drive, Tallahassee, FL 32308Certificate of waiverSep 24, 2027

National Provider Directory

National Provider Directory

Locations

2633 Centennial Blvd
Ste 100
Tallahassee, FL 32308
Phone (850) 431-5404

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548633600000",
    "number": "1386862852",
    "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": "1505 SURGEONS DRIVE",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "32308",
            "telephone_number": "850-431-4325",
            "fax_number": "850-431-3533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TALLAHASSEE MEMORIAL HEALTHCARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-23",
        "last_updated": "2019-01-28",
        "status": "A",
        "authorized_official_last_name": "MOSS",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "850-431-6256",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP #",
            "identifier": "24766A",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tallahassee, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.