Organization Active NPI

Trihealth

  • Family Medicine Physician
  • Cincinnati, OH
National Provider Identifier
1407050537
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
57010437 Issued in OH
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, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
57010437OtherOHMD TRAINING CERTIFICATE

Other names 1

  • Bethesda Family Medicine Residency Other name

National Provider Directory

National Provider Directory

NPI 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.

Verify at the official NPI Registry.