NPIMap

Organization Active NPI

Stockwell Reisman Paulk & Taylor PA

  • Gastroenterology Physician
  • Tallahassee, FL
National Provider Identifier
1871549998
Registry record updated Jan 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
STOCKWELL REISMAN PAULK & TAYLOR PA
Practice address
2400 Miccosukee Rd
Tallahassee, FL 32308-5314
Phone
(850) 877-2105
Fax
(850) 216-1321
NPI assigned
May 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2010

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

Authorized official

Name
Charlotte L Madani
Title
Business Office Manager
Phone
(850) 205-8404

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0100X Primary

Addresses

Primary practice location

2400 Miccosukee Rd
Tallahassee, FL 32308-5314

Mailing address

2400 Miccosukee Rd
Tallahassee, FL 32308-5314
Phone (850) 877-2105

Other identifiers 1

IdentifierTypeStateIssuer
374312800MedicaidFL

Other names 1

  • Digestive Disease Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040626000389 FL Part B Supplier - Clinic/Group Practice 8628054053 Receives reassigned benefits from 21 practitioners
Practice locations: Tallahassee, FL

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
10D0270132Digestive Disease Clinic2400 Miccosukee Rd 2ND FL, Tallahassee, FL 32308ComplianceSep 30, 2026

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1263254400000",
    "number": "1871549998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 MICCOSUKEE RD",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323085314",
            "telephone_number": "850-877-2105",
            "fax_number": "850-216-1321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 MICCOSUKEE RD",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323085314",
            "telephone_number": "850-877-2105",
            "fax_number": "850-216-1321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STOCKWELL REISMAN PAULK & TAYLOR PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-26",
        "last_updated": "2010-01-12",
        "status": "A",
        "authorized_official_last_name": "MADANI",
        "authorized_official_first_name": "CHARLOTTE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "BUSINESS OFFICE MANAGER",
        "authorized_official_telephone_number": "850-205-8404"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "374312800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Digestive Disease Clinic",
            "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 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.