NPIMap

Organization Active NPI

Tri-State Surgical Center, LLC

  • Anesthesiology Physician
  • Martinsburg, WV
National Provider Identifier
1053939074
Registry record updated Jul 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
TRI-STATE SURGICAL CENTER, LLC
Practice address
1006 Tavern Rd
Martinsburg, WV 25401-2864
Phone
(304) 267-0556
Fax
(304) 267-1460
NPI assigned
Jul 7, 2020
Last updated
Jul 9, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
TRI-STATE SURGICAL CENTER, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 9, 2020

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

Authorized official

Name
Hilda Lynn Hoffmaster
Title
Billing/Coding Manager
Phone
(304) 263-5129

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207L00000X Primary

Addresses

Primary practice location

1006 Tavern Rd
Martinsburg, WV 25401-2864

Mailing address

1006 Tavern Rd
Martinsburg, WV 25401-2864
Phone (304) 267-0556

Other identifiers 1

IdentifierTypeStateIssuer
6905041000MedicaidWV

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address hilda@cfoeonline.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031205000507 WV Part B Supplier - Ambulatory Surgical Center 9335044916 Receives reassigned benefits from 9 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Martinsburg, WV

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Tri State Surgical Cent2 organizations share this tax ID, including this one
Part of
Tri State Surgical Cent

Other organizations with this tax ID 1

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 11

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": "1594080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594252800000",
    "number": "1053939074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1006 TAVERN RD",
            "city": "MARTINSBURG",
            "state": "WV",
            "postal_code": "254012864",
            "telephone_number": "304-267-0556",
            "fax_number": "304-267-1460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1006 TAVERN RD",
            "city": "MARTINSBURG",
            "state": "WV",
            "postal_code": "254012864",
            "telephone_number": "304-267-0556",
            "fax_number": "304-267-1460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-STATE SURGICAL CENTER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TRI-STATE SURGICAL CENTER, LLC",
        "enumeration_date": "2020-07-07",
        "last_updated": "2020-07-09",
        "certification_date": "2020-07-09",
        "status": "A",
        "authorized_official_last_name": "HOFFMASTER",
        "authorized_official_first_name": "HILDA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "BILLING/CODING MANAGER",
        "authorized_official_telephone_number": "304-263-5129"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6905041000",
            "state": "WV"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hilda@cfoeonline.com",
            "affiliation": "N",
            "endpointDescription": "business email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1006 Tavern Rd",
            "city": "Martinsburg",
            "state": "WV",
            "country_code": "US",
            "postal_code": "254012864",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Martinsburg, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.