NPIMap

Organization Active NPI

Tallahassee Memorial Healthcare Inc

Doing business as Tallahassee Memorial Hospital Extended Care

  • Skilled Nursing Facility
  • Tallahassee, FL
National Provider Identifier
1649387119
Registry record updated Jan 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
TALLAHASSEE MEMORIAL HEALTHCARE INC
Doing business as
Tallahassee Memorial Hospital Extended Care
Practice address
1609 Medical Dr
Tallahassee, FL 32308-4617
Phone
(850) 431-5324
Fax
(850) 431-6322
NPI assigned
Aug 23, 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 Jr.
Title
Administrator
Phone
(850) 431-6256

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

1609 Medical Dr
Tallahassee, FL 32308-4617

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
L87OtherFLBLUE CROSS PROVIDER #
010113300MedicaidFL

Other names 1

  • Tallahassee Memorial Hospital Extended Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100119000563 FL Part A Provider - Skilled Nursing Facility 6103724778 Practice locations: Tallahassee, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1649387119. Details of each certification follow.

Skilled nursing facility certification: CCN 105158

Legal name
TALLAHASSEE MEMORIAL HEALTHCARE INC
Doing business as
TALLAHASSEE MEMORIAL HOSPITAL EXTENDED CARE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 1, 1979
Last certification
Jan 11, 2024
Beds
113
Ownership / control type
Nonprofit Corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 29, 1979 in FL
Enrollment address
1609 Medical Dr
Tallahassee, FL 32308-4617
Nursing home name
TALLAHASSEE MEMORIAL HOSPITAL EXTENDED CARE

Other NPIs with the same Medicare PAC ID 10

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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Tallahassee Memorial Hospital Extended CareCCN 105158 · All quality measures
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
5 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Jul 1, 1979
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
11347.0 residents per day on average
Penalties (3 years)
1Fines totaling $8,018

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Tallahassee Memorial Em38 organizations share this tax ID, including this one

Other organizations with this tax ID 37

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

View all 37

Ownership & related parties

All disclosed owners & managing parties 27

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

NameRoleSinceShare
James S Killius Individual Corporate DirectorDirector Oct 1, 2013
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 OfficerChair Oct 1, 2013
Corporate DirectorDirector Oct 1, 2006
William Giudice Individual Corporate OfficerChief Financial Officer Oct 1, 1986
W-2 Managing EmployeeChief Financial Officer Oct 1, 1986
Paula S Fortunas Individual Corporate OfficerChief Development Officer Jan 19, 2004
W-2 Managing EmployeeChief Development Officer Jan 19, 2004
Alma Littles Individual Corporate OfficerTreasurer Oct 1, 2013
Corporate DirectorDirector Oct 1, 2008
Robin L Moss Individual Corporate OfficerExecutive Director Oct 1, 2000
W-2 Managing EmployeeExecutive Director Jan 3, 1994
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
Joseph L Camps Individual Corporate DirectorDirector Sep 24, 2004
Robert L Moore Individual Corporate OfficerChief Human Resources Officer Apr 14, 2013
W-2 Managing EmployeeChief Human Resources Officer Apr 14, 2013
Erin Ennis Individual Corporate DirectorDirector Oct 1, 2005
George M Obryant Individual Corporate OfficerPresident/Ceo Jul 14, 2003
W-2 Managing EmployeePresident/Ceo Jul 14, 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
Christopher S Rumana Individual Corporate DirectorDirector Oct 1, 2011
Susie Busch Transou Individual Corporate OfficerSecretary Oct 1, 2013
Corporate DirectorDirector Oct 1, 2007
Laurie Dozier Individual Corporate DirectorDirector Oct 1, 2005
Frank Gredler Individual Corporate OfficerChair-Elect Oct 1, 2013
Corporate DirectorDirector Oct 1, 2006
Rick Moore Individual Corporate DirectorDirector Oct 1, 2007
Martha W Barnett Individual Corporate DirectorDirector Oct 1, 2012
Steven L Evans Individual Corporate DirectorDirector 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 6

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

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548633600000",
    "number": "1649387119",
    "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": "1609 MEDICAL DR",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323084617",
            "telephone_number": "850-431-5324",
            "fax_number": "850-431-6322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TALLAHASSEE MEMORIAL HEALTHCARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-23",
        "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": "ADMINISTRATOR",
        "authorized_official_telephone_number": "850-431-6256",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROVIDER #",
            "identifier": "L87",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010113300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tallahassee Memorial Hospital Extended Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Tallahassee Memorial Hospital Extended Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tallahassee, FL

Sources for this page

Verify at the official NPI Registry.