NPIMap

Organization Active NPI

Summit Medical Group, Inc

Doing business as St. Elizabeth Physicians

  • Ophthalmology Physician
  • Covington, KY
National Provider Identifier
1780959833
Registry record updated Aug 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
SUMMIT MEDICAL GROUP, INC
Doing business as
St. Elizabeth Physicians
Practice address
1500 James Simpson Jr Way Ste 201
Covington, KY 41011-0802
Phone
(859) 655-3111
Fax
(859) 655-3110
NPI assigned
Mar 21, 2012
Last updated
Aug 8, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2025

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

Authorized official

Name
Maria Rankin
Title
Avp-Revenue Cycle
Phone
(859) 344-5555

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Ophthalmology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207W00000X Primary

Addresses

Primary practice location

1500 James Simpson Jr Way Ste 201
Covington, KY 41011-0802

Mailing address

1360 Dolwick Dr
Erlanger, KY 41018-3127
Phone (859) 344-5555

Other names 1

  • St. Elizabeth Physicians Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120614000172 KY DME Supplier - Physician - Family Practice 2163326240 Practice locations: Covington, KY

Other NPIs with the same Medicare PAC ID 10

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

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
18D0324074St Elizabeth Physicians1500 James Simpson Jr Way, Suite 201, Covington, KY 41011Provider-performed microscopyDec 31, 2027
18D2270529St Elizabeth Physicians1500 James Simpson Jr Way Suite 302, Covington, KY 41011Certificate of waiverOct 17, 2026

National Provider Directory

National Provider Directory
Tax ID family
Summit Medical Groupinc18 organizations share this tax ID, including this one

Other organizations with this tax ID 17

Organizations that report the same tax identification number in the National Provider Directory.

View all 17

Locations

1500 James Simpson Jr Way
Ste 201
Covington, KY 41011
Phone (859) 344-5481

NPI Registry JSON

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

{
    "created_epoch": "1332288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754611200000",
    "number": "1780959833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1360 DOLWICK DR",
            "city": "ERLANGER",
            "state": "KY",
            "postal_code": "410183127",
            "telephone_number": "859-344-5555",
            "fax_number": "859-344-5552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 JAMES SIMPSON JR WAY STE 201",
            "city": "COVINGTON",
            "state": "KY",
            "postal_code": "410110802",
            "telephone_number": "859-655-3111",
            "fax_number": "859-655-3110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT MEDICAL GROUP, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-21",
        "last_updated": "2025-08-08",
        "certification_date": "2025-08-08",
        "status": "A",
        "authorized_official_last_name": "RANKIN",
        "authorized_official_first_name": "MARIA",
        "authorized_official_title_or_position": "AVP-REVENUE CYCLE",
        "authorized_official_telephone_number": "859-344-5555"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Elizabeth Physicians",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St. Elizabeth Physicians",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Covington, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2025; 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.