Triad Health Systems Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

TRIAD HEALTH SYSTEMS INC.

Practice address

329 Floyd Dr
Carrollton, KY 41008-8261

Phone

(502) 732-1082

Fax

(859) 567-1253

NPI assigned

Jan 14, 2014

Last updated

Nov 7, 2018By the provider in NPPES

Organization subpart

Yes

Parent organization

TRIAD HEALTH SYSTEMS INC.As reported in NPPES

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

Authorized official

Name

Jessica Wheeler

Title

General Manager

Phone

(859) 567-1271

Specialties & licenses 4

Addresses

Other names 1

• Triad Health Systems Carrollton Clinic Other name

Medicare fee-for-service enrollment

Enrolled in KY

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104248962. Details of each certification follow.

• CCN 181035 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 181035

Legal name

TRIAD HEALTH SYSTEMS, INC

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Aug 23, 2017

Last certification

Aug 23, 2017

Ownership / control type

For profit – corporation

Facility address

329 Floyd Dr
Carrollton, KY 41008

Other NPIs on the same Medicare enrollment 1

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

• Triad Health Systems, Inc.

  • Federally Qualified Health Center (FQHC)
  • Warsaw, KY
  • NPI 1831311299

  O20100806000077

  Same enrollment

Part of

Triad Health Systems Inc

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.

• Triad Health Systems, Inc.

  • Federally Qualified Health Center (FQHC)
  • Warsaw, KY
  • NPI 1831311299
  NPPES parent name

Practitioners 3

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.

• Stacey Marie Caldwell

  • Family Nurse Practitioner
  • Carrollton, KY
  • NPI 1811852205

  Federally Qualified Health Center (FQHC)

  NPD
• Sheila Freeman, LCSW

  • Clinical Social Worker
  • Lexington, KY
  • NPI 1316902232
  NPD
• Larry J Gross, MD

  • Neurology Physician
  • Covington, KY
  • NPI 1518921329
  NPD

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

{
    "created_epoch": "1389657600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1541548800000",
    "number": "1104248962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 845",
            "city": "WARSAW",
            "state": "KY",
            "postal_code": "410950845",
            "telephone_number": "859-567-1591",
            "fax_number": "859-567-1253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "329 FLOYD DR",
            "city": "CARROLLTON",
            "state": "KY",
            "postal_code": "410088261",
            "telephone_number": "502-732-1082",
            "fax_number": "859-567-1253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRIAD HEALTH SYSTEMS INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TRIAD HEALTH SYSTEMS INC.",
        "enumeration_date": "2014-01-14",
        "last_updated": "2018-11-07",
        "status": "A",
        "authorized_official_last_name": "WHEELER",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "GENERAL MANAGER",
        "authorized_official_telephone_number": "859-567-1271"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "KY",
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "KY",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Triad Health Systems Carrollton Clinic",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Triad Health Systems Carrollton Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Sy Dan Nguyen, PSC
• The Mind Pillow Counseling
• Three Rivers District Health Department (Carroll County Health Center)
• Three Rivers District Health Department
• Together in Care LLC
• Triad Health Systems, Inc. (Triad Health Systems Pharmacy)
• Kathryn Nicole Trueblood, PHARMD
• Amanda M Vickers, D.O
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-2968)
• Walgreen Co (Walgreens #17241)

• Federally Qualified Health Center (FQHC) in Carrollton, KY
• Providers in Carrollton, KY by specialty
• Federally Qualified Health Center (FQHC) in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.