NPIMap

Organization Active NPI

Florida Department of Children and Families

Doing business as Florida State Hospital

  • Psychiatric Hospital
  • Chattahoochee, FL
National Provider Identifier
1578895470
Registry record updated Nov 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
License
3990 Issued in FL
Legal business name
FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES
Doing business as
Florida State Hospital
Practice address
100 N Main St
Chattahoochee, FL 32324-1107
Phone
(850) 663-7802
Fax
(850) 663-7516
NPI assigned
Feb 3, 2010
Last updated
Nov 18, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
FLORIDA DEPARTMENT OF CHILDREN AND FAMILIESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 18, 2020

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

Authorized official

Name
Mr. Stephen B Lewallen
Title
Hospital Administrator
Phone
(850) 663-7536

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X 3990 FL Primary

Addresses

Primary practice location

100 N Main St
Chattahoochee, FL 32324-1107

Mailing address

100 N Main St
Financial SVCS., BLDG 1260, 3Rd Floor
Chattahoochee, FL 32324-1107
Phone (850) 663-7802

Other identifiers 1

IdentifierTypeStateIssuer
026001100MedicaidFL

Other names 1

  • Florida State Hospital Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031222000351 FL Part B Supplier - Clinic/Group Practice 5092613570 Receives reassigned benefits from 90 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Chattahoochee, FL; Macclenny, FL
O20080411000179 FL Part A Provider - Hospital 5092613570 1 other NPI on this enrollment
Practice locations: Chattahoochee, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1578895470. Details of each certification follow.

Hospital certification: CCN 104000

Legal name
FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES
Doing business as
FLORIDA STATE HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Jul 1, 1966
Last certification
Oct 28, 2021
Beds
949 (34 certified)
Ownership / control type
State
Organization structure
OtherNon-profit
Enrollment address
100 N Main St
Chattahoochee, FL 32324-1107
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric, Psychiatric unit

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Florida State Hospital Unit 14 PsychCCN 104000 · All quality measures
Type
Psychiatric
Ownership
Government - State
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory
Tax ID family
FL Department of Childr9 organizations share this tax ID, including this one
Part of
FL Department of Childr

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Locations

100 N Main St
Chattahoochee, FL 32324
Phone (850) 663-7001

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Rena Flynn Individual W-2 Managing EmployeeSmhtf Revenue Director Sep 27, 1998
Diana Nielsen Individual W-2 Managing EmployeeChief Financial Officer Jan 3, 2012
Florida Department of Children and Families Organization, Chattahoochee, FL Operational/Managerial Control May 8, 2012 100%
Stephen Lewallen Individual 5% Or Greater Direct Ownership InterestActing Hospital Administrator Oct 12, 2020 100%

Owners & managing parties with NPI records 3

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
Florida State HospitalChattahoochee, FL, CCN 100298 Hospital Operational/Managerial Control (100%) Jan 1, 1990

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 48

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.

View all 48

NPI Registry JSON

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

{
    "created_epoch": "1265155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605657600000",
    "number": "1578895470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N MAIN ST",
            "address_2": "FINANCIAL SVCS., BLDG 1260, 3RD FLOOR",
            "city": "CHATTAHOOCHEE",
            "state": "FL",
            "postal_code": "323241107",
            "telephone_number": "850-663-7802",
            "fax_number": "850-663-7516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N MAIN ST",
            "city": "CHATTAHOOCHEE",
            "state": "FL",
            "postal_code": "323241107",
            "telephone_number": "850-663-7802",
            "fax_number": "850-663-7516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES",
        "enumeration_date": "2010-02-03",
        "last_updated": "2020-11-18",
        "certification_date": "2020-11-18",
        "status": "A",
        "authorized_official_last_name": "LEWALLEN",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "HOSPITAL ADMINISTRATOR",
        "authorized_official_telephone_number": "850-663-7536",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "FL",
            "license": "3990",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "026001100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Florida State Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Florida State Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chattahoochee, FL

Sources for this page

Verify at the official NPI Registry.