Katrina L Tripp, PAC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

085004472 Issued in IL

Practice address

7211 US 45 S
Carrier Mills, IL 62917-1305

Phone

(618) 209-0498

Fax

(618) 724-4628

NPI assigned

Oct 1, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Katrina L Holcomb Former name

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: katrinatripp@hbmc.allscriptsdirect.net
• Direct secure messaging: katrina.tripp@hmcclinic.directbygreenway.com

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

• Southern Illinois Medical Services, NFP

  dba SIH Medical Group

  • Internal Medicine Physician
  • Carbondale, IL
  • NPI 1770656837
  Medicare reassignment NPD
• Harrisburg Medical Center Inc

  dba Eldorado Primary Care

  • Rural Health Clinic/Center
  • Eldorado, IL
  • NPI 1073646436
  NPD

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

{
    "created_epoch": "1349049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662595200000",
    "number": "1578814414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 155",
            "city": "CHRISTOPHER",
            "state": "IL",
            "postal_code": "628220155",
            "telephone_number": "618-724-2401",
            "fax_number": "618-724-4628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7211 US 45 S",
            "city": "CARRIER MILLS",
            "state": "IL",
            "postal_code": "629171305",
            "telephone_number": "618-209-0498",
            "fax_number": "618-724-4628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRIPP",
        "first_name": "KATRINA",
        "middle_name": "L",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-01",
        "last_updated": "2022-09-08",
        "certification_date": "2022-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085004472",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATRINA",
            "last_name": "HOLCOMB",
            "middle_name": "L",
            "credential": "PAC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Nathan Kyle Heady, PA-C
• Kelley M Mitchell X, LPN
• Jennifer Elaine Price, PA-C
• Nikki Reed, M.S. SLP-CCC
• Stacy Lynn Sumner
• Nicole Poythress Waters, DO, PHD

• Physician Assistant in Carrier Mills, IL
• Providers in Carrier Mills, IL by specialty
• Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.