NPIMap

Organization Active NPI

Bond Community Health Center, Inc.

Doing business as Bond on Magnolia

  • Federally Qualified Health Center (FQHC)
  • Tallahassee, FL
National Provider Identifier
1770084824
Registry record updated Dec 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
BOND COMMUNITY HEALTH CENTER, INC.
Doing business as
Bond on Magnolia
Practice address
2200 South Monroe
Tallahassee, FL 32301
Phone
(850) 576-4073
Fax
(850) 577-0675
NPI assigned
Feb 23, 2018
Last updated
Dec 2, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 2, 2025

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

Authorized official

Name
Mrs. Deirdre Vickers, BS
Title
Billing Supervisor
Phone
(850) 576-4073

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

2200 South Monroe
Tallahassee, FL 32301

Mailing address

1720 S Gadsden St
Tallahassee, FL 32301-5506
Phone (850) 576-4073

Other names 1

  • BOND ON MAGNOLIA Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180518000314 FL Part A Provider - Federally Qualified Health Center (FQHC) 5294646766 Practice locations: Tallahassee, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1770084824. Details of each certification follow.

Federally qualified health center certification: CCN 681124

Legal name
BOND COMMUNITY HEALTH CENTER, INC.
Doing business as
BOND ON MAGNOLIA
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 18, 2018
Last certification
May 18, 2018
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Enrollment address
2200 S Monroe St
Tallahassee, FL 32301-6303

Other NPIs with the same Medicare PAC ID 1

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2162539Bond on Magnolia2200 S Monroe St, Tallahassee, FL 32301Certificate of waiverFeb 24, 2027

National Provider Directory

National Provider Directory
Tax ID family
Bond Comm Med Assocs5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

1549 S Monroe St
Tallahassee, FL 32301
Phone (850) 576-4073

2700 Municipal Way
Tallahassee, FL 32304
Phone 8505764073301

710 Orange Ave W
Tallahassee, FL 32310
Phone (850) 576-4073

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
David J Hill Individual Corporate Director Mar 23, 2016
Antonio Jefferson Individual Corporate DirectorBoardmember Jun 1, 2012
Mia Rosario Individual Corporate Director Jan 1, 2015
Bevelyn Perry Individual Corporate Director May 18, 2016
Olu Sawyer Individual Corporate Director Jan 1, 2015
William Lamar Individual Corporate DirectorBoard Member Apr 1, 2011
John Grayson Individual W-2 Managing EmployeeChief Financial Officer Oct 1, 2014
Sharon Ofuani Individual Corporate Director Jan 1, 2016
Peter Okonkwo Individual Corporate Director May 1, 2013
Delores Lawson Individual Corporate Director Jun 1, 2012
Temple Robinson Individual 5% Or Greater Direct Ownership Interest Oct 29, 2014
Corporate DirectorChief Executive Officer Oct 1, 2013

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1519344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1764633600000",
    "number": "1770084824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 S GADSDEN ST",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323015506",
            "telephone_number": "850-576-4073",
            "fax_number": "850-577-0675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 SOUTH MONROE",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "32301",
            "telephone_number": "850-576-4073",
            "fax_number": "850-577-0675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOND COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-23",
        "last_updated": "2025-12-02",
        "certification_date": "2025-12-02",
        "status": "A",
        "authorized_official_last_name": "VICKERS",
        "authorized_official_first_name": "DEIRDRE",
        "authorized_official_title_or_position": "BILLING SUPERVISOR",
        "authorized_official_telephone_number": "850-576-4073",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "BS"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BOND ON MAGNOLIA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tallahassee, FL

Sources for this page

Verify at the official NPI Registry.