NPIMap

Organization Active NPI

Tri-Rivers Healthcare PLLC

Doing business as Marion Physicians Clinic

  • Rural Health Clinic/Center
  • Marion, KY
National Provider Identifier
1699895003
Registry record updated Jul 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
900215 Issued in KY
Legal business name
TRI-RIVERS HEALTHCARE PLLC
Doing business as
Marion Physicians Clinic
Practice address
308 S Main St
Marion, KY 42064-1545
Phone
(270) 965-4377
Fax
(270) 965-9569
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
Rural Health Clinic/Center 261QR1300X 900215 KY Primary
Medical Physician Assistant 363AM0700X NU
Family Nurse Practitioner 363LF0000X NU
Internal Medicine Physician 207R00000X NU
Surgery Physician 208600000X NU
General Practice Physician 208D00000X NU

Addresses

Primary practice location

308 S Main St
Marion, KY 42064-1545

Mailing address

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

Other identifiers 3

IdentifierTypeStateIssuer
6590103500MedicaidKY
7100091570MedicaidKY
7890094100MedicaidKY

Other names 1

  • Marion Physicians 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
This NPI is an additional NPI on the enrollment
Practice locations: Marion, KY; Salem, KY; Smithland, KY
O20080919000334 KY Part A Provider - Rural Health Clinic 8426965278 Practice locations: Marion, KY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1699895003. Details of each certification follow.

Rural health clinic certification: CCN 183960

Legal name
TRI-RIVERS HEALTHCARE PLLC
Doing business as
MARION PHYSISICANS CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 9, 2008
Last certification
Oct 5, 2015
Ownership / control type
1C
Organization structure
LLCProprietary
Incorporated
Nov 22, 1999 in KY
Enrollment address
308S Main St
Marion, KY 42064-1545

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.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
18D0971152Tri Rivers Healthcare PLLC308 South Main Street, Marion, KY 42064Certificate of waiverMar 6, 2028

National Provider Directory

National Provider Directory

Locations

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

131 Hospital Dr
#103
Salem, KY 42078

131 Hospital Dr
Ste 103
Salem, KY 42078

141 Hospital Dr
#102
Salem, KY 42078

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 InterestMember Feb 25, 2008 50%
Corporate DirectorMedical Director Feb 25, 2008 100%
Michael Heneisen Individual W-2 Managing EmployeeBusiness Director Feb 25, 2008 100%
Ghassan Yazigi Individual 5% Or Greater Direct Ownership InterestMember Feb 25, 2008 50%
Corporate DirectorMedical Director Feb 25, 2008 100%

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 13

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 13

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": "1699895003",
    "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": "308 S MAIN ST",
            "city": "MARION",
            "state": "KY",
            "postal_code": "420641545",
            "telephone_number": "270-965-4377",
            "fax_number": "270-965-9569"
        }
    ],
    "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": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "KY",
            "license": "900215",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6590103500",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100091570",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7890094100",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Marion Physicians Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marion, KY

Sources for this page

Verify at the official NPI Registry.