NPIMap

Organization Active NPI

Tallahassee Memorial Healthcare Inc

Doing business as TMH Behavioral Health Group

  • Psychiatric Hospital Unit
  • Tallahassee, FL
National Provider Identifier
1811941834
Registry record updated Jan 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
License
4080 Issued in FL
Legal business name
TALLAHASSEE MEMORIAL HEALTHCARE INC
Doing business as
TMH Behavioral Health Group
Practice address
1616 Physicians Dr
Tallahassee, FL 32308-4619
Phone
(850) 431-5100
Fax
(850) 431-6105
NPI assigned
May 22, 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
Title
Executive Director
Phone
(850) 431-6256

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YA0400X 4080 FL
Mental Health CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YM0800X 4080 FL
PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103T00000X 4080 FL
Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 104100000X 4080 FL
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X 4080 FL
Psychiatry PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084P0800X 4080 FL
Psychiatric Hospital Unit 273R00000X 4080 FL Primary

Addresses

Primary practice location

1616 Physicians Dr
Tallahassee, FL 32308-4619

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
375270417MedicaidFL
24766OOtherBLUE CROSS BLUE SHEILD

Other names 1

  • TMH Behavioral Health Group Doing business as

Medicare participation

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

Enrollment records 2

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…
O20121003000793 FL Part A Provider - Hospital 6103724778 Practice locations: Tallahassee, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1811941834. Details of each certification follow.

Hospital certification: CCN 10S135

Legal name
TALLAHASSEE MEMORIAL HEALTHCARE INC
Doing business as
TALLAHASSEE MEMORIAL BEHAVIOR HEALTH CENTER
Organization structure
CorporationNon-profit
Incorporated
Jun 29, 1979 in FL
Enrollment address
1616 Physicians Dr
Tallahassee, FL 32308-4619
Main/Primary Hospital Location
Hospital subgroups
Psychiatric unit

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

Other NPIs with the same Medicare PAC ID 10

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

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

Ownership & related parties

All disclosed owners & managing parties 28

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

NameRoleSinceShare
Avery D McKnight Individual Corporate DirectorBoard Member Oct 1, 2013
Mary L Pankowski Individual Corporate DirectorBoard Member Oct 1, 2016
Andrea K Friall Individual Corporate OfficerVice President/Cmo Nov 1, 2016
Harold Avon Doll Individual Corporate DirectorBoard Member Oct 1, 2016
William Giudice Individual Corporate OfficerVice President/Cfo Oct 1, 1986
W-2 Managing EmployeeVice President/Cfo Oct 1, 1986
Alma Littles Individual Corporate DirectorChair, Board Member Oct 1, 2008
Brant Copeland Individual Corporate DirectorBoard Member Oct 1, 2014
Donald W Lindsey Individual Corporate OfficerVice President/Cio Mar 2, 2008
Dean Watson Individual Corporate OfficerVice President/Choo Jan 3, 2010
George M Obryant Individual Corporate OfficerPresident/Ceo Feb 1, 2012 100%
W-2 Managing Employee Jul 14, 2003
Andrew M Wong Individual Corporate DirectorBoard Member Oct 1, 2013
Cynthia Blair Individual Corporate OfficerViec President/Cimprovo May 23, 2005
Jennifer Parks Individual Corporate Officer Jan 1, 2025
W-2 Managing EmployeePresident Jan 1, 2025
Steven E Haynes Individual Corporate DirectorVice President/HR Apr 3, 2017
Christopher S Rumana Individual Corporate DirectorSecretary, Board Member Oct 1, 2011
Tallahassee Memorial Healthcare Inc Organization, Tallahassee, FL Non-profit Operational/Managerial Control Jun 29, 1979 100%
Erman E Murray Individual Corporate DirectorBoard Member Oct 1, 2015
Stephanie M Derzypolski Individual Corporate OfficerVice President/Cco Jan 1, 2017
Frank Gredler Individual Corporate DirectorBoard Member Oct 1, 2006
Lee Hinkle Individual Corporate DirectorBoard Member Oct 1, 2014
Martha W Barnett Individual Corporate DirectorTreasurer, Board Member Oct 1, 2012
Thomas L Truman Individual Corporate DirectorBoard Member Oct 1, 2014
Mickey S Moore Individual Corporate OfficerVice President/Cao May 9, 2016
Steven L Evans Individual Corporate DirectorChair-Elect, Board Member Oct 1, 2012
Carmel S Dozier Individual Corporate DirectorBoard Member Oct 1, 2016
Barbara E Alford Individual Corporate OfficerVice President/Cpco/Cno Mar 10, 2013
Gary E Winchester Individual Corporate DirectorBoard Member Oct 1, 2011
Winston Howell Individual Corporate DirectorBoard Member Oct 1, 2013

Owners & managing parties with NPI records 17

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

View all 17

Practitioners & affiliated clinicians

Practitioners 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1148256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548633600000",
    "number": "1811941834",
    "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": "1616 PHYSICIANS DR",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323084619",
            "telephone_number": "850-431-5100",
            "fax_number": "850-431-6105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TALLAHASSEE MEMORIAL HEALTHCARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-22",
        "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": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "850-431-6256",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "FL",
            "license": "4080",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "4080",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "FL",
            "license": "4080",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": "FL",
            "license": "4080",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "4080",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "4080",
            "primary": false
        },
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "FL",
            "license": "4080",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "375270417",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHEILD",
            "identifier": "24766O",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TMH Behavioral Health Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tallahassee, FL

Sources for this page

Verify at the official NPI Registry.