NPIMap

Organization Active NPI

Tallahassee Memorial Healthcare Inc

Doing business as FSU/TMH Internal Medicine Residency Program

  • Internal Medicine Physician
  • Tallahassee, FL
National Provider Identifier
1740545128
Registry record updated Jan 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4080 Issued in FL
Legal business name
TALLAHASSEE MEMORIAL HEALTHCARE INC
Doing business as
FSU/TMH Internal Medicine Residency Program
Practice address
1300 Miccosukee Road
Internal Medicine Residency Program
Tallahassee, FL 32308-5607
Phone
(850) 431-7900
Fax
(850) 431-7990
NPI assigned
Jul 11, 2012
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. George M O'Bryant
Title
Ceo
Phone
(850) 431-5380

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4080 FL Primary

Addresses

Primary practice location

1300 Miccosukee Road
Internal Medicine Residency Program
Tallahassee, FL 32308-5607

Mailing address

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

Other names 1

  • FSU/TMH Internal Medicine Residency Program Doing business as

Medicare participation

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

Enrollment records 1

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…

Other NPIs on the same Medicare enrollment 39

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

View all 39

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

Practitioners & affiliated clinicians

Practitioners 8

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": "1341964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548633600000",
    "number": "1740545128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1607 SAINT JAMES CT",
            "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": "1300 MICCOSUKEE ROAD",
            "address_2": "INTERNAL MEDICINE RESIDENCY PROGRAM",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323085607",
            "telephone_number": "850-431-7900",
            "fax_number": "850-431-7990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TALLAHASSEE MEMORIAL HEALTHCARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-11",
        "last_updated": "2019-01-28",
        "status": "A",
        "authorized_official_last_name": "O'BRYANT",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "850-431-5380",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "FL",
            "license": "4080",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FSU/TMH Internal Medicine Residency Program",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "FSU/TMH Internal Medicine Residency Program",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tallahassee, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.