NPIMap

Organization Active NPI

TMC Tallapoosa Family Healthcare Center

  • Rural Health Clinic/Center
  • Tallapoosa, GA
National Provider Identifier
1497760243
Registry record updated Feb 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
TMC TALLAPOOSA FAMILY HEALTHCARE CENTER
Practice address
25 W Lyon St
Tallapoosa, GA 30176-1288
Phone
(770) 824-2800
Fax
(770) 824-2810
NPI assigned
Jul 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 29, 2024

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

Authorized official

Name
Clint Hoffman
Title
Sr VP
Phone
(770) 838-8845

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

25 W Lyon St
Tallapoosa, GA 30176-1288

Mailing address

100 Greenway Blvd FL 2
Carrollton, GA 30117-4338
Phone (770) 838-8710

Other identifiers 3

IdentifierTypeStateIssuer
367607289BOtherGACLINIC RENDERING NUMBER
540960632AMedicaidGA
CH7677OtherGAMEDICARE ID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20030407000031 GA Part A Provider - Rural Health Clinic 0042129074 Practice locations: Tallapoosa, GA
O20050809000615 GA Part B Supplier - Clinic/Group Practice 0042129074 Receives reassigned benefits from 8 practitioners
Practice locations: Tallapoosa, GA

Rural health clinic certification: CCN 118504

Legal name
TMC TALLAPOOSA FAMILY HEALTHCARE CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 8, 2003
Last certification
Aug 13, 2024
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Apr 8, 1998 in GA
Enrollment address
25W Lyon St
Tallapoosa, GA 30176-1288
Related CCNs
111320

Facilities connected through Provider of Services related, parent or unit certification numbers.

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Locations

5 E Alabama St
Tallapoosa, GA 30176
Phone (770) 574-5666

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
Susan Fox Individual Operational/Managerial ControlVP of Operations Mar 12, 2013 80%
Jillian Ragsdale Individual Corporate DirectorDirector of Finance Feb 12, 2010
Operational/Managerial ControlDirector of Finance Feb 12, 2010

Practitioners & affiliated clinicians

Practitioners 9

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

NPI Registry JSON

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

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709164800000",
    "number": "1497760243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 GREENWAY BLVD FL 2",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301174338",
            "telephone_number": "770-838-8710",
            "fax_number": "770-812-5735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 W LYON ST",
            "city": "TALLAPOOSA",
            "state": "GA",
            "postal_code": "301761288",
            "telephone_number": "770-824-2800",
            "fax_number": "770-824-2810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TMC TALLAPOOSA FAMILY HEALTHCARE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-30",
        "last_updated": "2024-02-29",
        "certification_date": "2024-02-29",
        "status": "A",
        "authorized_official_last_name": "HOFFMAN",
        "authorized_official_first_name": "CLINT",
        "authorized_official_title_or_position": "SR VP",
        "authorized_official_telephone_number": "770-838-8845"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLINIC RENDERING NUMBER",
            "identifier": "367607289B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "540960632A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "CH7677",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tallapoosa, GA

Sources for this page

Verify at the official NPI Registry.