NPIMap

Organization Active NPI

Tri-Rivers Healthcare PLLC

Doing business as Smithland Medical Clinic

  • Rural Health Clinic/Center
  • Smithland, KY
National Provider Identifier
1598885998
Registry record updated Jul 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
900217 Issued in KY
Legal business name
TRI-RIVERS HEALTHCARE PLLC
Doing business as
Smithland Medical Clinic
Practice address
205 E Adair St
Smithland, KY 42081-9507
Phone
(270) 928-2146
Fax
(270) 928-4492
NPI assigned
Mar 30, 2007
Last updated
Jul 23, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2026

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

Authorized official

Name
Michael A Heneisen
Title
Agent
Phone
(270) 988-3298

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X
Rural Health Clinic/Center 261QR1300X 900217 KY Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

205 E Adair St
Smithland, KY 42081-9507

Mailing address

141 Hospital Dr
Salem, KY 42078-8043
Phone (270) 988-3298

Other names 1

  • Smithland Medical Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040511001797 KY Part B Supplier - Clinic/Group Practice 8426965278 Receives reassigned benefits from 15 practitioners
3 other NPIs on this enrollment
Practice locations: Marion, KY; Salem, KY; Smithland, KY
O20080919000370 KY Part A Provider - Rural Health Clinic 8426965278 Practice locations: Smithland, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1598885998. Details of each certification follow.

Rural health clinic certification: CCN 183962

Legal name
TRI-RIVERS HEALTHCARE PLLC
Doing business as
SMITHLAND MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 9, 2008
Last certification
Jul 1, 2015
Ownership / control type
1C
Organization structure
LLCProprietary
Incorporated
Nov 22, 1999 in KY
Enrollment address
205 E Adair Street
Smithland, KY 42081-9507

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory

Locations

220 S Main St
Marion, KY 42064
Phone (270) 965-4377

141 Hospital Dr
Salem, KY 42078
Phone (270) 988-3298

141 Hospital Dr
Ste 103
Salem, KY 42078
Phone (270) 988-3298

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
William Barnes Individual 5% Or Greater Direct Ownership Interest Feb 25, 2008
Corporate Director Feb 25, 2008
Michael Heneisen Individual W-2 Managing Employee Feb 25, 2008
Ghassan Yazigi Individual 5% Or Greater Direct Ownership Interest Feb 25, 2008
Corporate Director Feb 25, 2008

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784764800000",
    "number": "1598885998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 HOSPITAL DR",
            "city": "SALEM",
            "state": "KY",
            "postal_code": "420788043",
            "telephone_number": "270-988-3298",
            "fax_number": "270-988-4642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 E ADAIR ST",
            "city": "SMITHLAND",
            "state": "KY",
            "postal_code": "420819507",
            "telephone_number": "270-928-2146",
            "fax_number": "270-928-4492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-RIVERS HEALTHCARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-30",
        "last_updated": "2026-07-23",
        "certification_date": "2026-07-23",
        "status": "A",
        "authorized_official_last_name": "HENEISEN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "AGENT",
        "authorized_official_telephone_number": "270-988-3298"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "KY",
            "license": "900217",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Smithland Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Smithland, KY

Sources for this page

Verify at the official NPI Registry.