NPIMap

Organization Active NPI

Tri-State Pain Management Service Inc

  • Interventional Pain Medicine Physician
  • Cincinnati, OH
National Provider Identifier
1770565954
Registry record updated Mar 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
Legal business name
TRI-STATE PAIN MANAGEMENT SERVICE INC
Practice address
7655 Five Mile Rd
Ste 117
Cincinnati, OH 45230
Phone
(859) 341-7246
Fax
(513) 624-0578
NPI assigned
Nov 15, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2020

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

Authorized official

Name
Jewell Ashley
Title
Office Manager
Phone
(513) 624-7525

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Pain Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208VP0014X Primary
Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

7655 Five Mile Rd
Ste 117
Cincinnati, OH 45230

Mailing address

7655 5 Mile Rd Ste 117
Cincinnati, OH 45230-4326
Phone (513) 624-7525

Other identifiers 6

IdentifierTypeStateIssuer
728014OtherBUCKEYE
65944233MedicaidKY
2044773MedicaidOH
000000388145OtherANTHEM
200529320AMedicaidIN
5124498OtherCIGNA

Other names 1

  • Interventional Spine Specialists Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040407000793 OH Part B Supplier - Clinic/Group Practice 2163415829 Receives reassigned benefits from 3 practitioners
10 other NPIs on this enrollment
Practice locations: Cincinnati, OH

Other NPIs on the same Medicare enrollment 5

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
36D1095361Tri-State Pain Management Services7655 Five Mile Road Suite 117, Cincinnati, OH 45230Certificate of waiverFeb 5, 2027

National Provider Directory

National Provider Directory

Locations

1484 Solutions Ctr
Chicago, IL 60677

7700 University Dr
West Chester, OH 45069
Phone (513) 298-3000

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1132012800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1585008000000",
    "number": "1770565954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7655 5 MILE RD STE 117",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452304326",
            "telephone_number": "513-624-7525",
            "fax_number": "513-624-0578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7655 FIVE MILE RD",
            "address_2": "STE 117",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "45230",
            "telephone_number": "859-341-7246",
            "fax_number": "513-624-0578"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-STATE PAIN MANAGEMENT SERVICE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-15",
        "last_updated": "2020-03-24",
        "certification_date": "2020-03-24",
        "status": "A",
        "authorized_official_last_name": "ASHLEY",
        "authorized_official_first_name": "JEWELL",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "513-624-7525"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BUCKEYE",
            "identifier": "728014",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65944233",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2044773",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000388145",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200529320A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "5124498",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Interventional Spine Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cincinnati, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.