NPIMap

Organization Active NPI

Tri State Primary Care LLC

  • Internal Medicine Physician
  • Cincinnati, OH
National Provider Identifier
1225016298
Registry record updated Sep 4, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
TRI STATE PRIMARY CARE LLC
Practice address
4010 N Bend Rd
Cincinnati, OH 45211-3500
Phone
(513) 598-3500
Fax
(513) 598-3508
NPI assigned
Jan 9, 2006
Last updated
Sep 4, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2008

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

Authorized official

Name
Kelly Bernens
Title
Business Manager Physician Practice
Phone
(513) 559-2891

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X Primary

Addresses

Primary practice location

4010 N Bend Rd
Cincinnati, OH 45211-3500

Mailing address

PO Box 633359
Cincinnati, OH 45263-3359
Phone (513) 557-3330

Other identifiers 4

IdentifierTypeStateIssuer
200415580AMedicaidIN
2327682MedicaidOH
200415580BMedicaidIN
65939001MedicaidKY

National Provider Directory

National Provider Directory

Locations

4363 Bridgetown Rd
Cincinnati, OH 45211
Phone (513) 585-5100

Practitioners & affiliated clinicians

Practitioners 8

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": "1136764800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1220486400000",
    "number": "1225016298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 633359",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452633359",
            "telephone_number": "513-557-3330",
            "fax_number": "513-557-3199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4010 N BEND RD",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452113500",
            "telephone_number": "513-598-3500",
            "fax_number": "513-598-3508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI STATE PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-09",
        "last_updated": "2008-09-04",
        "status": "A",
        "authorized_official_last_name": "BERNENS",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "BUSINESS MANAGER PHYSICIAN PRACTICE",
        "authorized_official_telephone_number": "513-559-2891"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200415580A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2327682",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200415580B",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65939001",
            "state": "KY"
        }
    ],
    "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 Sep 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.