NPIMap

Organization Active NPI

Tri-State Gastroenterology P.C.

  • Gastroenterology Physician
  • Newburgh, IN
National Provider Identifier
1811935067
Registry record updated Apr 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
01038295 Issued in IN
Legal business name
TRI-STATE GASTROENTEROLOGY P.C.
Practice address
4133 Gateway Blvd
Suite 290
Newburgh, IN 47630-7953
Phone
(812) 842-2701
Fax
(812) 842-2717
NPI assigned
Jun 2, 2006
Last updated
Apr 15, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2014

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

Authorized official

Name
Gregory S McCord, MDNPI 1720116924
Title
Physician
Phone
(812) 842-2701

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X 01038295 IN Primary

Addresses

Primary practice location

4133 Gateway Blvd
Suite 290
Newburgh, IN 47630-7953

Mailing address

PO Box 5068
Evansville, IN 47716-5068
Phone (812) 842-2701

Other identifiers 6

IdentifierTypeStateIssuer
64871676MedicaidKY
000000042589OtherANTHEM
100180010AMedicaidIN
400746743MedicaidIL
100002411OtherRAILROAD MEDICARE
200073540AMedicaidIN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1397520000000",
    "number": "1811935067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5068",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477165068",
            "telephone_number": "812-842-2701",
            "fax_number": "812-842-2717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4133 GATEWAY BLVD",
            "address_2": "SUITE 290",
            "city": "NEWBURGH",
            "state": "IN",
            "postal_code": "476307953",
            "telephone_number": "812-842-2701",
            "fax_number": "812-842-2717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-STATE GASTROENTEROLOGY P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-02",
        "last_updated": "2014-04-15",
        "status": "A",
        "authorized_official_last_name": "MCCORD",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "812-842-2701",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "IN",
            "license": "01038295",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64871676",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000042589",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100180010A",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "400746743",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "100002411",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200073540A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Newburgh, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.