NPIMap

Summit Medical Group, Inc

Organization Active NPI Ophthalmology Physician · Covington, KY

NPI 1780959833 · NPPES record last updated Aug 8, 2025

Key facts

NPI
1780959833
Entity type
Organization (NPI type 2)
Primary specialty
Ophthalmology Physician 207W00000X
Legal business name
SUMMIT MEDICAL GROUP, INC
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
Organization subpart
No

Authorized official

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

Other NPIs with the same Medicare PAC ID 10

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

Corporate family (same tax ID) 17

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

Practitioners 803

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

View all 803

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
18D0324074St Elizabeth Physicians
1500 James Simpson Jr Way, Suite 201, Covington, KY 41011		Provider-performed microscopyDec 31, 2027
18D2270529St Elizabeth Physicians
1500 James Simpson Jr Way Suite 302, Covington, KY 41011		Certificate of waiverOct 17, 2026

Medicare participation

Medicare fee-for-service enrollment
Enrolled in KY

Medicare enrollment records

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

National Provider Directory

Tax ID family
Summit Medical Groupinc (18 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist
Group: 193200000X MULTI-SPECIALTY GROUP		 152W00000X
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X
Ophthalmology Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207W00000X Yes

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

  • St. Elizabeth Physicians Doing business as

Other providers in Covington, KY

All providers in Covington, KY · Ophthalmology Physician in Kentucky

Sources for this page

Verify at the official NPI Registry.