NPIMap

Organization Active NPI

Tristate Img (Imaging Medical Group) Inc

  • Specialist
  • Cincinnati, OH
National Provider Identifier
1114927209
Registry record updated Aug 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
TRISTATE IMG (IMAGING MEDICAL GROUP) INC
Practice address
375 Dixmyth Ave
Cincinnati, OH 45220
Phone
(513) 965-8041
Fax
(513) 965-8091
NPI assigned
Jul 29, 2005
Last updated
Aug 16, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 16, 2018

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

Authorized official

Name
Lynn Gray
Title
Client Services Manager
Phone
(513) 965-8041

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X NU Primary

Addresses

Primary practice location

375 Dixmyth Ave
Cincinnati, OH 45220

Mailing address

PO Box 42456
Cincinnati, OH 45242-0456
Phone (513) 965-8041

Other identifiers 3

IdentifierTypeStateIssuer
0318981MedicaidOH
65920043MedicaidKY
100002830AMedicaidIN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031209001075 OH Part B Supplier - Clinic/Group Practice 6204732365 Receives reassigned benefits from 50 practitioners
Practice locations: Cincinnati, OH; Oxford, OH; Lebanon, OH; Fairfield Township, OH

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

2915 Clifton Ave
Cincinnati, OH 45220
Phone (513) 872-2000

500 E Business Way
#B
Cincinnati, OH 45241

500 E Business Way
Ste B
Cincinnati, OH 45241
Phone (513) 345-3787

Practitioners & affiliated clinicians

Practitioners 55

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.

View all 55

NPI Registry JSON

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

{
    "created_epoch": "1122595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534377600000",
    "number": "1114927209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 42456",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452420456",
            "telephone_number": "513-965-8041",
            "fax_number": "513-965-8091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "375 DIXMYTH AVE",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "45220",
            "telephone_number": "513-965-8041",
            "fax_number": "513-965-8091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRISTATE IMG (IMAGING MEDICAL GROUP) INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-29",
        "last_updated": "2018-08-16",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "LYNN",
        "authorized_official_title_or_position": "CLIENT SERVICES MANAGER",
        "authorized_official_telephone_number": "513-965-8041"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0318981",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65920043",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100002830A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cincinnati, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 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.