NPIMap

Individual provider Active NPI

Tristan Grose, APRN, FNP-BC

  • Family Nurse Practitioner
  • Charleston, WV
National Provider Identifier
1740872415
Registry record updated Jan 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
107176 Issued in WV
Practice address
415 Morris St Ste 400
Charleston, WV 25301-1854
Phone
(304) 344-3551
NPI assigned
Feb 4, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 107176 WV Primary

Addresses

Primary practice location

415 Morris St Ste 400
Charleston, WV 25301-1854

Mailing address

415 Morris St Ste 400
Charleston, WV 25301-1854
Phone (304) 344-3551

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210427000483 WV Practitioner - Nurse Practitioner 9133537418 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Charleston Area Medical Center IncGroup PAC ID 3375441637, 969 clinicians

Practice addresses (Care Compare)

415 Morris St
Suite 400
Charleston, WV 25301-1854
Phone (304) 344-3551

Hospital & facility affiliations

  • Charleston Area Medical Center Hospital, Charleston, WV, CCN 510022
  • Boone Memorial Hospital Hospital, Madison, WV, CCN 511313
  • Camc Plateau Medical Center, Inc Hospital, Oak Hill, WV, CCN 511317
  • Camc Greenbrier Valley Medical Center, Inc Hospital, Ronceverte, WV, CCN 510002
  • Logan Regional Medical Center Hospital, Logan, WV, CCN 510048

Merit-based Incentive Payment System (MIPS)

Final score
90.94 of 100Reported as apm
Quality
69.71
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
107176WVMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Signify Health Medical Associates, PLLC CurrentSince Dec 13, 2022 Accepting new patients
Charleston Area Medical Center, Inc. CurrentSince Jan 20, 2024 Accepting new patients
Neurological Associates, Inc. CurrentSince Jan 1, 2022 Accepting new patients
Neurological Associates, Inc. CurrentSince Jan 1, 2022 Accepting new patients
Charleston Area Medical Center Inc Past Accepting new patients

Locations

4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037

100 Tracy Way
Charleston, WV 25311
Phone (304) 343-4583

400 Association Dr
Ste 102
Charleston, WV 25311
Phone (304) 388-1762

501 Morris St
Charleston, WV 25301
Phone (304) 348-6293

415 Morris St
Ste 400
Charleston, WV 25301
Phone (304) 344-3551

400 Prestige Park Dr
#A1
Hurricane, WV 25526
Phone (304) 334-3551

1400 Hospital Dr
Hurricane, WV 25526
Phone (304) 757-1700

Organizations & group practices 6

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.

Hospital & facility affiliations 16

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1612396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704758400000",
    "number": "1740872415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 MORRIS ST STE 400",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253011854",
            "telephone_number": "304-344-3551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 MORRIS ST STE 400",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253011854",
            "telephone_number": "304-344-3551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROSE",
        "first_name": "TRISTAN",
        "credential": "APRN, FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-04",
        "last_updated": "2024-01-09",
        "certification_date": "2024-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WV",
            "license": "107176",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, WV

Sources for this page

Verify at the official NPI Registry.