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Tri-Rivers Healthcare PLLC

Organization Active NPI Rural Health Clinic/Center · Smithland, KY

NPI 1598885998 · NPPES record last updated Jul 23, 2026

Key facts

NPI
1598885998
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
License
900217 (KY)
Legal business name
TRI-RIVERS HEALTHCARE PLLC
Practice address
205 E Adair St
Smithland, KY 42081-9507
Phone
(270) 928-2146
Fax
(270) 928-4492
NPI assigned
Mar 30, 2007
Organization subpart
No

Authorized official

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

Owners & managing parties with NPI records 2

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

  • William Edris Barnes II, MD General Practice Physician · Salem, KY · NPI 1215985148
    CMS ownership 5% OR GREATER DIRECT OWNERSHIP INTEREST · CORPORATE DIRECTOR
  • Ghassan Yazigi, MD Internal Medicine Physician · Salem, KY · NPI 1538127378
    CMS ownership 5% OR GREATER DIRECT OWNERSHIP INTEREST · CORPORATE DIRECTOR

Other NPIs on the same Medicare enrollment 3

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

Other NPIs with the same Medicare PAC ID 2

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

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in KY

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
LLC · Proprietary
Incorporated
Nov 22, 1999 in KY
Enrollment address
205 E Adair Street
Smithland, KY 42081-9507

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

Medicare enrollment records

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

National Provider Directory

Locations

141 Hospital Dr
Ste 102
Salem, KY 42078
Phone (270) 988-3298

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X
Internal Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207R00000X
Surgery Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 208600000X
General Practice Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 208D00000X
Rural Health Clinic/Center 261QR1300X 900217 KY Yes
Family Nurse Practitioner
Group: 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 identifiers

IdentifierTypeStateIssuer
7890094100MedicaidKY
7100091610MedicaidKY
6590103500MedicaidKY

Other names

  • Smithland Medical Clinic Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 23, 2026.

{
    "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7890094100",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100091610",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6590103500",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Smithland Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Smithland, KY

All providers in Smithland, KY · Rural Health Clinic/Center in Kentucky

Sources for this page

Verify at the official NPI Registry.