NPIMap

Organization Active NPI

Neighborhood Medical Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Havana, FL
National Provider Identifier
1952816225
Registry record updated Mar 25, 2022
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
604 E 5TH Ave
Havana, FL 32333-1442
Phone
(850) 539-9800
NPI assigned
Dec 8, 2017
Last updated
Mar 25, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
1487869467As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 25, 2022

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

Authorized official

Name
Nellie R Graham, MSCJ
Title
Human Resources
Phone
(850) 577-0045

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

604 E 5TH Ave
Havana, FL 32333-1442

Mailing address

438 W Brevard St
Tallahassee, FL 32301-1004
Phone (850) 224-2469

Other identifiers 3

IdentifierTypeStateIssuer
112812501MedicaidFL
112864300MedicaidFL
112812500MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140602001944 FL Part A Provider - Federally Qualified Health Center (FQHC) 7517082837 Practice locations: Havana, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1952816225. Details of each certification follow.

Federally qualified health center certification: CCN 101154

Legal name
NEIGHBORHOOD MEDICAL CENTER, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 2, 2014
Last certification
Jun 2, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 3, 1974 in FL
Enrollment address
604 E 5TH Ave
Havana, FL 32333-1442

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Tax ID family
The Neighborhood Health8 organizations share this tax ID, including this one
Part of
The Neighborhood Health

Other organizations with this tax ID 7

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

Locations

1210 Kemp Rd
Havana, FL 32333
Phone (850) 539-0065

604 E 5th Ave
Havana, FL 32333
Phone (850) 224-2469

Ownership & related parties

All disclosed owners & managing parties 2

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 Corporate OfficerCeo Apr 12, 2016
Corporate DirectorChief Executive Office Apr 12, 2016
W-2 Managing EmployeeCeo Apr 12, 2017
Neighborhood Medical Center, Inc Organization, Havana, FL Other Apr 12, 2016

Owners & managing parties with NPI records 4

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
Neighborhood Medical Center, IncTallahassee, FL, CCN 681126 Federally qualified health center Operational/Managerial Control Apr 1, 2016

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 7

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": "1512691200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648166400000",
    "number": "1952816225",
    "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": "850-224-2469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "604 E 5TH AVE",
            "city": "HAVANA",
            "state": "FL",
            "postal_code": "323331442",
            "telephone_number": "850-539-9800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEIGHBORHOOD MEDICAL CENTER, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "1487869467",
        "enumeration_date": "2017-12-08",
        "last_updated": "2022-03-25",
        "certification_date": "2022-03-25",
        "status": "A",
        "authorized_official_last_name": "GRAHAM",
        "authorized_official_first_name": "NELLIE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "HUMAN  RESOURCES",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112812501",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112864300",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "112812500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Havana, FL

Sources for this page

Verify at the official NPI Registry.