NPIMap

Organization Active NPI

Tallahassee Memorial Healthcare Inc

  • Rural Health Clinic/Center
  • Blountstown, FL
National Provider Identifier
1437108271
Registry record updated Jan 28, 2019
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
17808 NE Charlie Johns St
Blountstown, FL 32424-1052
Phone
(850) 674-4524
Fax
(850) 674-2300
NPI assigned
May 9, 2006
Last updated
Jan 28, 2019By the provider in NPPES
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) 431-6259

Specialties & licenses 2

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

Addresses

Primary practice location

17808 NE Charlie Johns St
Blountstown, FL 32424-1052

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
6600379-00MedicaidFL
375270403MedicaidFL

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…
O20100215000782 FL Part A Provider - Rural Health Clinic 6103724778 Practice locations: Blountstown, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1437108271. Details of each certification follow.

Rural health clinic certification: CCN 103997

Legal name
TALLAHASSEE MEMORIAL HEALTHCARE INC
Doing business as
TMH PHYSICIAN PARTNERS, BLOUNTSTOWN
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 31, 1994
Last certification
Jul 2, 2019
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jun 29, 1979 in FL
Enrollment address
17808 Charley Johns St
Blountstown, FL 32424-1052
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

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
10D0699255TMH Physician Partners Blountstown17808 NE Charley Johns St, Blountstown, FL 32424Provider-performed microscopyAug 10, 2027

National Provider Directory

National Provider Directory

Locations

17808 NE Charlie Johns St
Blountstown, FL 32424
Phone (850) 674-4524

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 DirectorSecretary 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 Human Resources Officer Apr 14, 2013
W-2 Managing EmployeeChief Human Resources Officer Apr 14, 2013
George M Obryant Individual Corporate OfficerChief Executive Officer Jul 14, 2013
W-2 Managing EmployeeChief Executive Officer Jul 4, 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 OfficerPresident Jan 1, 2025
W-2 Managing Employee Jan 1, 2025
Christopher S Rumana Individual Corporate DirectorDirector Oct 1, 2011
Susie Busch Transou Individual Corporate OfficerChair Elect Oct 1, 2014
Corporate DirectorChair Elect Oct 1, 2007
Frank Gredler Individual Corporate OfficerChair Oct 1, 2014
Corporate DirectorChairman 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 OfficerTreasurer Oct 1, 2014
Corporate DirectorTreasurer 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 3

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.

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": "1548633600000",
    "number": "1437108271",
    "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": "17808 NE CHARLIE JOHNS ST",
            "city": "BLOUNTSTOWN",
            "state": "FL",
            "postal_code": "324241052",
            "telephone_number": "850-674-4524",
            "fax_number": "850-674-2300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TALLAHASSEE MEMORIAL HEALTHCARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-09",
        "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": "850-431-6259",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "FL",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6600379-00",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "375270403",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Blountstown, FL

Sources for this page

Verify at the official NPI Registry.