Active NPI
Trihealth
- Family Medicine Physician
- Cincinnati, OH
National Provider Identifier
1407050537
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 57010437
- Legal business name
- TRIHEALTH
- Practice address
- 4411 Montgomery Rd
#206
Cincinnati, OH 45212-3187 - Phone
- (513) 631-0763
- NPI assigned
- Jun 13, 2007
- Last updated
- Aug 22, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Tracie L Bolden, MD
- Title
- Resident
- Phone
- (513) 631-0763
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 57010437 | OH | Primary |
Addresses
Primary practice location
4411 Montgomery Rd
#206
Cincinnati, OH 45212-3187
Mailing address
4411 Montgomery Rd
#206
Cincinnati, OH 45212-3187
Phone (513) 631-0763
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 57010437 | Other | OH | MD TRAINING CERTIFICATE |
Other names 1
- Bethesda Family Medicine Residency
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181692800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1407050537",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4411 MONTGOMERY RD",
"address_2": "#206",
"city": "CINCINNATI",
"state": "OH",
"postal_code": "452123187",
"telephone_number": "513-631-0763"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4411 MONTGOMERY RD",
"address_2": "#206",
"city": "CINCINNATI",
"state": "OH",
"postal_code": "452123187",
"telephone_number": "513-631-0763"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "TRIHEALTH",
"organizational_subpart": "NO",
"enumeration_date": "2007-06-13",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "BOLDEN",
"authorized_official_first_name": "TRACIE",
"authorized_official_middle_name": "L",
"authorized_official_title_or_position": "RESIDENT",
"authorized_official_telephone_number": "513-631-0763",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "OH",
"license": "57010437",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MD TRAINING CERTIFICATE",
"identifier": "57010437",
"state": "OH"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Bethesda Family Medicine Residency",
"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 Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.