NPIMap

Organization Active NPI

Neighborhood Medical Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Tallahassee, FL
National Provider Identifier
1851806079
Registry record updated Mar 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NEIGHBORHOOD MEDICAL CENTER, INC
Practice address
872 W Orange Ave
Tallahassee, FL 32310-6123
Phone
(850) 606-8226
NPI assigned
Dec 11, 2017
Last updated
Mar 28, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
1487869467As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 28, 2023

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

Authorized official

Name
Nellie R Graham, MSCJ
Title
Credentialing Manager
Phone
(850) 577-0045

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
General Practice Dentistry 1223G0001X NU

Addresses

Primary practice location

872 W Orange Ave
Tallahassee, FL 32310-6123

Mailing address

438 W Brevard St
Tallahassee, FL 32301-1004
Phone (850) 577-0045

Other identifiers 3

IdentifierTypeStateIssuer
112863500MedicaidFL
112812300MedicaidFL
112813702MedicaidFL

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100909001205 FL Part B Supplier - Clinic/Group Practice 7517082837 Receives reassigned benefits from 21 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Tallahassee, FL; Havana, FL
O20140604000032 FL Part A Provider - Federally Qualified Health Center (FQHC) 7517082837 1 other NPI on this enrollment
Practice locations: Tallahassee, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1851806079. Details of each certification follow.

Federally qualified health center certification: CCN 101159

Legal name
NEIGHBORHOOD MEDICAL CENTER, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 4, 2014
Last certification
Jun 4, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 3, 1974 in FL
Enrollment address
872 W Orange Ave
Tallahassee, FL 32310-6123

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Tax ID family
The Neighborhood8 organizations share this tax ID, including this one
Part of
The Neighborhood

Other organizations with this tax ID 7

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

Locations

2295 Pasco St
Tallahassee, FL 32310
Phone (850) 224-2409

3013 Jim Lee Rd
Tallahassee, FL 32301
Phone (850) 391-5585

Ownership & related parties

All disclosed owners & managing parties 1

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

NameRoleSinceShare
Jeanne Freeman Individual W-2 Managing EmployeeCeo Nov 25, 2015
Operational/Managerial Control Nov 25, 2015

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Neighborhood Medical Center, IncHavana, FL, CCN 101154 Federally qualified health center Other Apr 12, 2016
Neighborhood Medical Center, IncTallahassee, FL, CCN 681126 Federally qualified health center Operational/Managerial Control Apr 1, 2016

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 1

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": "1512950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679961600000",
    "number": "1851806079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "438 W BREVARD ST",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323011004",
            "telephone_number": "850-577-0045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "872 W ORANGE AVE",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323106123",
            "telephone_number": "850-606-8226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEIGHBORHOOD MEDICAL CENTER, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "1487869467",
        "enumeration_date": "2017-12-11",
        "last_updated": "2023-03-28",
        "certification_date": "2023-03-28",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "NELLIE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "850-577-0045",
        "authorized_official_credential": "MSCJ"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112863500",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112812300",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112813702",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tallahassee, FL

Sources for this page

Verify at the official NPI Registry.