NPIMap

Organization Active NPI

Tristate Orthopaedic Treatment Center, Inc.

  • Orthopaedic Surgery Physician
  • Cincinnati, OH
National Provider Identifier
1295746691
Registry record updated May 20, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
TRISTATE ORTHOPAEDIC TREATMENT CENTER, INC.
Practice address
10547 Montgomery Road
Suite 400
Cincinnati, OH 45242-4418
Phone
(513) 791-6611
Fax
(513) 791-6788
NPI assigned
Aug 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2014

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

Authorized official

Name
Dr. Clyde E Henderson Jr., M.D.
Title
President
Phone
(513) 791-6611

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X
Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207X00000X Primary
Occupational Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2083X0100X
Foot & Ankle Surgery PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213ES0103X
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X

Addresses

Primary practice location

10547 Montgomery Road
Suite 400
Cincinnati, OH 45242-4418

Mailing address

10547 Montgomery Road
Suite 400
Cincinnati, OH 45242-4418
Phone (513) 791-6611

Other identifiers 4

IdentifierTypeStateIssuer
0946007MedicaidOH
200025270BMedicaidIN
200025270DMedicaidIN
200025270CMedicaidIN

Other names 1

  • TOTC Other name

National Provider Directory

National Provider Directory

Locations

2100 Sherman Ave
Ste 105
Cincinnati, OH 45212

770 Reading Rd
Ste B
Mason, OH 45040

Practitioners & affiliated clinicians

Practitioners 9

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": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400544000000",
    "number": "1295746691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10547 MONTGOMERY ROAD",
            "address_2": "SUITE 400",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452424418",
            "telephone_number": "513-791-6611",
            "fax_number": "513-791-6788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10547 MONTGOMERY ROAD",
            "address_2": "SUITE 400",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452424418",
            "telephone_number": "513-791-6611",
            "fax_number": "513-791-6788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRISTATE ORTHOPAEDIC TREATMENT CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2014-05-20",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "CLYDE",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "513-791-6611",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2083X0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0946007",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200025270B",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200025270D",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200025270C",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TOTC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 May 20, 2014; 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.