NPIMap

Individual provider Active NPI

Michelle Lynn Davis, CNP

  • Gerontology Nurse Practitioner
  • Cincinnati, OH
National Provider Identifier
1407239767
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
3010585 Issued in KY
Practice address
10475 Reading Road
Ste 117
Cincinnati, OH 45241-2500
Phone
(513) 559-1222
Fax
(513) 559-1235
NPI assigned
Jul 6, 2015
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X CREDENTIAL LICENSE OH
Gerontology Nurse Practitioner 363LG0600X 3010585 KY Primary

Addresses

Primary practice location

10475 Reading Road
Ste 117
Cincinnati, OH 45241-2500

Mailing address

10475 Reading Road
Ste 117
Cincinnati, OH 45241-2500
Phone (513) 559-1222

Other identifiers 2

IdentifierTypeStateIssuer
K208050OtherKYMEDICARE PTAN
7100439080MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY, OH2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20160923001643 KY Practitioner - Nurse Practitioner 9234426966 Reassigns benefits to 1 organization
I20180612002485 OH Practitioner - Nurse Practitioner 9234426966 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

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

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.83 of 100Reported as group
Promoting interoperability
98
Improvement activities
40
Cost
83.09

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
CREDENTIAL LICENSEOHMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Tri State Urologic Services PSC Inc CurrentSince Oct 18, 2022 Accepting new patients
Tri State Urologic Services PSC Inc Current Accepting new patients
Tri State Urologic Services PSC Inc CurrentSince Oct 18, 2022 Accepting new patients

Locations

4360 Ferguson Dr
Ste 100
Cincinnati, OH 45245
Phone (513) 841-7750

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

Interoperability endpoints

  • Direct secure messaging: michelledavis@tsus.allscriptsdirect.net

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1436140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1407239767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10475 READING ROAD",
            "address_2": "STE 117",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452412500",
            "telephone_number": "513-559-1222",
            "fax_number": "513-559-1235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10475 READING ROAD",
            "address_2": "STE 117",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452412500",
            "telephone_number": "513-559-1222",
            "fax_number": "513-559-1235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "MICHELLE",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-07-06",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": "CREDENTIAL LICENSE",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "KY",
            "license": "3010585",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "K208050",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100439080",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cincinnati, OH

Sources for this page

Verify at the official NPI Registry.