NPIMap

Organization Active NPI

Tallahassee Memorial Healthcare Inc.

  • Family Medicine Physician
  • Quincy, FL
National Provider Identifier
1811953128
Registry record updated Jan 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
TALLAHASSEE MEMORIAL HEALTHCARE INC.
Practice address
178 Lasalle Lefall Dr
Quincy, FL 32351-5278
Phone
(850) 875-3600
Fax
(850) 627-7277
NPI assigned
Apr 25, 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) 431-7021

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary
Pediatrics Physician 208000000X NU
Rural Health Clinic/Center 261QR1300X NU

Addresses

Primary practice location

178 Lasalle Lefall Dr
Quincy, FL 32351-5278

Mailing address

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

Other identifiers 3

IdentifierTypeStateIssuer
375270401MedicaidFL
6600379-02MedicaidFL
24766COtherFLBCBS GROUP NUMBER

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…
O20100301000971 FL Part A Provider - Rural Health Clinic 6103724778 Practice locations: Quincy, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1811953128. Details of each certification follow.

Rural health clinic certification: CCN 103429

Legal name
TALLAHASSEE MEMORIAL HEALTHCARE INC
Doing business as
TMH PHYSICIAN PARTNERS, QUINCY
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 9, 1998
Last certification
Jul 17, 2024
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jun 29, 1979 in FL
Enrollment address
178 Lesalle Lefall Dr
Tallahassee Memorial Family Medicine
Quincy, FL 32351-5278
Related CCNs
100135

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 26

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 DirectorMember Oct 1, 2012
Warren E Jones Individual Corporate OfficerChief Communication Officer Mar 8, 2004
Jason Moore Individual Corporate OfficerChief Operating Officer Jul 7, 2008
William Giudice Individual Corporate OfficerCfo Oct 1, 1986
Paula S Fortunas Individual Corporate OfficerChief Development Officer Jan 19, 2004
Alma Littles Individual Corporate DirectorChair-Elect Oct 1, 2008
Brant Copeland Individual Corporate DirectorMember Oct 1, 2014
Robin L Moss Individual W-2 Managing Employee Jan 11, 2010
Other Jan 11, 2010
Donald W Lindsey Individual Corporate OfficerChief Information Officer Mar 2, 2008
Dean Watson Individual Corporate OfficerChief Medical Officer Jan 3, 2010
George M Obryant Individual Corporate OfficerCeo Jul 14, 2003
Andrew M Wong Individual Corporate DirectorMember Oct 1, 2013
Cynthia Blair Individual Corporate OfficerChief Improvement Officer May 23, 2005
Christopher S Rumana Individual Corporate DirectorMember Oct 1, 2011
Susie Busch Transou Individual Corporate DirectorChair Oct 1, 2007
Erman E Murray Individual Corporate DirectorMember Oct 1, 2015
Frank Gredler Individual Corporate DirectorMember Oct 1, 2006
Lee Hinkle Individual Corporate DirectorMember Oct 1, 2014
Rick Moore Individual Corporate DirectorMember Oct 1, 2007
Martha W Barnett Individual Corporate DirectorMember Oct 1, 2012
Thomas L Truman Individual Corporate DirectorMember Oct 1, 2014
Steven L Evans Individual Corporate DirectorSecretary Oct 1, 2012
Barbara E Alford Individual Corporate OfficerChief Nursing Officer Mar 10, 2013
Gary E Winchester Individual Corporate DirectorMember Oct 1, 2011
Winston Howell Individual Corporate DirectorMember Oct 1, 2013
Alberto L Fernandez Individual Corporate DirectorMember Oct 1, 2015

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

Practitioners 42

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 42

NPI Registry JSON

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

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548633600000",
    "number": "1811953128",
    "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": "178 LASALLE LEFALL DR",
            "city": "QUINCY",
            "state": "FL",
            "postal_code": "323515278",
            "telephone_number": "850-875-3600",
            "fax_number": "850-627-7277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TALLAHASSEE MEMORIAL HEALTHCARE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-25",
        "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": "850-431-7021",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "375270401",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6600379-02",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP NUMBER",
            "identifier": "24766C",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Quincy, FL

Sources for this page

Verify at the official NPI Registry.