NPIMap

Organization Active NPI

Tri State Urologic Services PSC Inc

Doing business as The Urology Group

  • Urology Physician
  • Lawrenceburg, IN
National Provider Identifier
1083807093
Registry record updated Jan 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
TRI STATE UROLOGIC SERVICES PSC INC
Doing business as
The Urology Group
Practice address
605 Wilson Creek Rd
Suite 01
Lawrenceburg, IN 47025-2506
Phone
(859) 363-2200
Fax
(859) 363-2201
NPI assigned
Aug 22, 2007
Last updated
Jan 11, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2017

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

Authorized official

Name
Earl L Walz
Title
Ceo
Phone
(513) 841-7400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X Primary

Addresses

Primary practice location

605 Wilson Creek Rd
Suite 01
Lawrenceburg, IN 47025-2506

Mailing address

2000 Joseph E Sanker Blvd
Cincinnati, OH 45212-1979
Phone (513) 841-7400

Other identifiers 2

IdentifierTypeStateIssuer
DN9528OtherINRAIROAD MEDICARE
200091770AMedicaidIN

Other names 1

  • THE UROLOGY GROUP Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070226000433 IN Part B Supplier - Clinic/Group Practice 6204740889 Receives reassigned benefits from 6 practitioners
3 other NPIs on this enrollment
Practice locations: Lawrenceburg, IN

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 1

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

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
15D1052335Urology Group, the605 Wilson Creek Rd, Lawrenceburg, IN 47025Provider-performed microscopyMar 22, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

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": "1187740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1484092800000",
    "number": "1083807093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 JOSEPH E SANKER BLVD",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452121979",
            "telephone_number": "513-841-7400",
            "fax_number": "513-841-7402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 WILSON CREEK RD",
            "address_2": "SUITE 01",
            "city": "LAWRENCEBURG",
            "state": "IN",
            "postal_code": "470252506",
            "telephone_number": "859-363-2200",
            "fax_number": "859-363-2201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI STATE UROLOGIC SERVICES PSC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-22",
        "last_updated": "2017-01-11",
        "status": "A",
        "authorized_official_last_name": "WALZ",
        "authorized_official_first_name": "EARL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "513-841-7400"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIROAD MEDICARE",
            "identifier": "DN9528",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200091770A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "THE UROLOGY GROUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lawrenceburg, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2017; 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.