NPIMap

Organization Active NPI

Tri-State Centers for Sight, Inc.

  • Ophthalmology Physician
  • Crestview Hills, KY
National Provider Identifier
1467520296
Registry record updated Feb 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
TRI-STATE CENTERS FOR SIGHT, INC.
Practice address
2865 Chancellor Dr
Suite 210
Crestview Hills, KY 41017-3912
Phone
(859) 331-6616
Fax
(859) 331-5760
NPI assigned
Dec 1, 2006
Last updated
Feb 12, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2024

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

Authorized official

Name
Candice B Davis
Title
Chief Revenue Cycle Officer
Phone
(916) 990-7590

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X Primary

Addresses

Primary practice location

2865 Chancellor Dr
Suite 210
Crestview Hills, KY 41017-3912

Mailing address

PO Box 631662
Cincinnati, OH 45263-1662
Phone (859) 581-7120

Other identifiers 4

IdentifierTypeStateIssuer
100002110 LMedicaidIN
77903425MedicaidKY
0382330MedicaidOH
65925760MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040219000102 KY Part B Supplier - Clinic/Group Practice 7113812090 Receives reassigned benefits from 31 practitioners
17 other NPIs on this enrollment
Practice locations: Mount Sterling, KY; Versailles, KY; Paintsville, KY; Morehead, KY; Middlesboro, KY; Maysville, KY; Lexington, KY; London, KY…

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 17

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 17

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 34

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.

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1164931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707696000000",
    "number": "1467520296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 631662",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452631662",
            "telephone_number": "859-581-7120",
            "fax_number": "859-581-7207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2865 CHANCELLOR DR",
            "address_2": "SUITE 210",
            "city": "CRESTVIEW HILLS",
            "state": "KY",
            "postal_code": "410173912",
            "telephone_number": "859-331-6616",
            "fax_number": "859-331-5760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-STATE CENTERS FOR SIGHT, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-01",
        "last_updated": "2024-02-12",
        "certification_date": "2024-02-12",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "CANDICE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CHIEF REVENUE CYCLE OFFICER",
        "authorized_official_telephone_number": "916-990-7590"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100002110 L",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "77903425",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0382330",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65925760",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Crestview Hills, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.