NPIMap

Organization Active NPI

Neighborhood Medical Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Tallahassee, FL
National Provider Identifier
1487869467
Registry record updated Mar 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NEIGHBORHOOD MEDICAL CENTER, INC
Practice address
438 W Brevard St
Tallahassee, FL 32301-1004
Phone
(850) 224-2469
Fax
(850) 513-3277
NPI assigned
May 11, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2023

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

Authorized official

Name
Mrs. Jeanne S Freeman, MSN
Title
Executive Director
Phone
(850) 459-2328

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

438 W Brevard St
Tallahassee, FL 32301-1004

Mailing address

438 W Brevard St
Tallahassee, FL 32301-1004
Phone (850) 224-2469

Other identifiers 4

IdentifierTypeStateIssuer
262263701MedicaidFL
112813300MedicaidFL
112813301MedicaidFL
262263702MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL5 enrollments

Enrollment records 5

Enrollment IDStateProvider typePAC IDDetails
O20100909001205 FL Part B Supplier - Clinic/Group Practice 7517082837 Receives reassigned benefits from 21 practitioners
3 other NPIs on this enrollment
Practice locations: Tallahassee, FL; Havana, FL
O20140603002508 FL Part A Provider - Federally Qualified Health Center (FQHC) 7517082837 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tallahassee, FL
O20140604000032 FL Part A Provider - Federally Qualified Health Center (FQHC) 7517082837 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tallahassee, FL
O20140604000154 FL Part A Provider - Federally Qualified Health Center (FQHC) 7517082837 Practice locations: Havana, FL
O20140604000428 FL Part A Provider - Federally Qualified Health Center (FQHC) 7517082837 Practice locations: Tallahassee, FL

Federally qualified health center certification: CCN 101161

Legal name
NEIGHBORHOOD MEDICAL CENTER, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 3, 2014
Last certification
Jun 3, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 3, 1974 in FL
Enrollment address
2295 Pasco St
Tallahassee, FL 32310-0908

Federally qualified health center certification: CCN 101159

Legal name
NEIGHBORHOOD MEDICAL CENTER, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 4, 2014
Last certification
Jun 4, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 3, 1974 in FL
Enrollment address
872 W Orange Ave
Tallahassee, FL 32310-6123

Federally qualified health center certification: CCN 101160

Legal name
NEIGHBORHOOD MEDICAL CENTER, INC
Organization structure
CorporationNon-profit
Incorporated
Jun 3, 1974 in FL
Enrollment address
1210 Kemp Rd
Havana, FL 32333-1938

Federally qualified health center certification: CCN 101162

Legal name
NEIGHBORHOOD MEDICAL CENTER, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 4, 2014
Last certification
Jun 4, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 3, 1974 in FL
Enrollment address
438 W Brevard St
Tallahassee, FL 32301-1004

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory

Locations

604 E 5th Ave
Havana, FL 32333
Phone (850) 224-2469

2613 S Monroe St
Tallahassee, FL 32301
Phone (850) 577-0045

438 W Brevard St
Tallahassee, FL 32301
Phone (850) 224-2469

Ownership & related parties

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Nellie Graham Individual W-2 Managing EmployeeHuman Resources Apr 15, 2014
Jeanne Freeman Individual Corporate OfficerCeo Nov 15, 2015
W-2 Managing EmployeeCeo Nov 25, 2015
Operational/Managerial Control Nov 25, 2015
Corporate OfficerChief Executive Officer Apr 1, 2016
Corporate OfficerCeo Apr 12, 2016
W-2 Managing EmployeeCeo Apr 12, 2016

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Neighborhood Medical Center, IncHavana, FL, CCN 101154 Federally qualified health center Other Apr 12, 2016
Neighborhood Medical Center, IncTallahassee, FL, CCN 681126 Federally qualified health center Operational/Managerial Control Apr 1, 2016

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 26

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

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1178841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679961600000",
    "number": "1487869467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "438 W BREVARD ST",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323011004",
            "telephone_number": "850-224-2469",
            "fax_number": "850-224-1139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "438 W BREVARD ST",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323011004",
            "telephone_number": "850-224-2469",
            "fax_number": "850-513-3277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEIGHBORHOOD MEDICAL CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-11",
        "last_updated": "2023-03-28",
        "certification_date": "2023-03-28",
        "status": "A",
        "authorized_official_last_name": "FREEMAN",
        "authorized_official_first_name": "JEANNE",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "850-459-2328",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MSN"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "262263701",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112813300",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112813301",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "262263702",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tallahassee, FL

Sources for this page

Verify at the official NPI Registry.