NPIMap

Organization Active NPI

Internal Medicine and Pediatrics Associatesof Tallahassee Inc

  • Substance Abuse Rehabilitation Facility
  • Tallahassee, FL
National Provider Identifier
1982922829
Registry record updated Dec 1, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Abuse Rehabilitation FacilityTaxonomy code 324500000X
Legal business name
INTERNAL MEDICINE AND PEDIATRICS ASSOCIATESOF TALLAHASSEE INC
Practice address
1965 Capital Cir NE
Suite 102
Tallahassee, FL 32308-8401
Phone
(850) 671-4600
Fax
(850) 878-2863
NPI assigned
May 16, 2010
Organization subpart
Yes
Parent organization
INTERNAL MEDICINE AND PEDIATRICS ASSOCIATESOF TALLAHASSEE INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 1, 2017

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

Authorized official

Name
Yvette Mignon, MDNPI 1689743288
Title
Owner
Phone
(850) 656-2006

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101Y00000X 8447 FL
Mental Health CounselorGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 101YM0800X 8447 FL
Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 104100000X 6702 FL
Clinical Social WorkerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1041C0700X 6702 FL
Substance Abuse Rehabilitation Facility 324500000X FL Primary
Substance Abuse Rehabilitation Facility 324500000X

Addresses

Primary practice location

1965 Capital Cir NE
Suite 102
Tallahassee, FL 32308-8401

Mailing address

1965 Capital Cir NE Ste 200
Tallahassee, FL 32308-8402
Phone (850) 656-2006

Other identifiers 5

IdentifierTypeStateIssuer
600680931OtherFLMAGELLAN
2386OtherGALICENSED PROFESSIONAL COUNSELOR
648299630AMedicaidGA
003214900MedicaidFL
8447OtherFLLICENSED MENTAL HEALTH COUNSELOR

Other names 1

  • IMPACT BEHAVIORAL HEALTH LLC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Internal Medicine Ped2 organizations share this tax ID, including this one
Part of
Internal Medicine Ped

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1273968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1512086400000",
    "number": "1982922829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1965 CAPITAL CIR NE STE 200",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323088402",
            "telephone_number": "850-656-2006",
            "fax_number": "850-656-2820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1965 CAPITAL CIR NE",
            "address_2": "SUITE 102",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323088401",
            "telephone_number": "850-671-4600",
            "fax_number": "850-878-2863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNAL MEDICINE AND PEDIATRICS ASSOCIATESOF TALLAHASSEE INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INTERNAL MEDICINE AND PEDIATRICS ASSOCIATESOF TALLAHASSEE INC",
        "enumeration_date": "2010-05-16",
        "last_updated": "2017-12-01",
        "status": "A",
        "authorized_official_last_name": "MIGNON",
        "authorized_official_first_name": "YVETTE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "850-656-2006",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor",
            "state": "FL",
            "license": "8447",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "8447",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": "FL",
            "license": "6702",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "6702",
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": "FL",
            "license": null,
            "primary": true
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN",
            "identifier": "600680931",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSED PROFESSIONAL COUNSELOR",
            "identifier": "2386",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "648299630A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003214900",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSED MENTAL HEALTH COUNSELOR",
            "identifier": "8447",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "IMPACT BEHAVIORAL HEALTH LLC",
            "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 Dec 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.