Organization Active NPI

Triad Health Systems Inc.

  • Federally Qualified Health Center (FQHC)
  • Carrollton, KY
National Provider Identifier
1104248962
Registry record updated Nov 7, 2018
On this page

Key facts

NPPES NPI Registry
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
Organization subpart
Yes
Parent organization
TRIAD HEALTH SYSTEMS INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 7, 2018

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

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X
Federally Qualified Health Center (FQHC) 261QF0400X KY Primary
Primary Care Clinic/Center 261QP2300X KY
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X KY

Addresses

Primary practice location

329 Floyd Dr
Carrollton, KY 41008-8261

Mailing address

PO Box 845
Warsaw, KY 41095-0845
Phone (859) 567-1591

Other names 1

  • Triad Health Systems Carrollton Clinic Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100806000077 KY Part B Supplier - Clinic/Group Practice 4082798699 Receives reassigned benefits from 23 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Warsaw, KY; Owenton, KY; Carrollton, KY

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
Part of
Triad Health Systems Inc

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 3

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": "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"
        }
    ]
}

Other providers in Carrollton, KY

Sources for this page

  • 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.