NPIMap

Organization Active NPI

Tri State Urologic Services PSC Inc

Doing business as The Urology Group

  • Urology Physician
  • West Chester, OH
National Provider Identifier
1164615746
Registry record updated Feb 6, 2020
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
8020 Liberty Way
West Chester, OH 45069-2519
Phone
(513) 841-7910
Fax
(513) 841-7901
NPI assigned
Aug 27, 2007
Last updated
Feb 6, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2020

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 PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208800000X Primary

Addresses

Primary practice location

8020 Liberty Way
West Chester, OH 45069-2519

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
0276946MedicaidOH
CC2433OtherOHRAILROAD MEDICARE

Other names 1

  • THE UROLOGY GROUP Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031118000285 OH Part B Supplier - Clinic/Group Practice 6204740889 Receives reassigned benefits from 87 practitioners
26 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Wilmington, OH; West Chester, OH; Oxford, OH; Middletown, OH; Hamilton, OH; Fairfield, OH; Cincinnati, OH; Blue Ash, OH

Other NPIs on the same Medicare enrollment 11

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
36D2177952Urology Group, the8020 Liberty Way, Liberty Township, OH 45069Certificate of waiverJan 21, 2028

National Provider Directory

National Provider Directory

Locations

8020 Liberty Way
West Chester, OH 45069
Phone (513) 777-8300

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1188172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580947200000",
    "number": "1164615746",
    "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": "8020 LIBERTY WAY",
            "city": "WEST CHESTER",
            "state": "OH",
            "postal_code": "450692519",
            "telephone_number": "513-841-7910",
            "fax_number": "513-841-7901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI STATE UROLOGIC SERVICES PSC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-27",
        "last_updated": "2020-02-06",
        "certification_date": "2020-02-06",
        "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": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0276946",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CC2433",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "THE UROLOGY GROUP",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "THE UROLOGY GROUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Chester, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2020; 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.