Trista Mullins

Primary specialty

DentistTaxonomy code 122300000X

License

30.026333 Issued in OH

Practice address

11660 Upper Gilchrist Rd
Mount Vernon, OH 43050-9084

Phone

(740) 399-2200

NPI assigned

Aug 14, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Trista Wyman Former name

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Healthlinc, Inc.

  • Federally Qualified Health Center (FQHC)
  • Valparaiso, IN
  • NPI 1528262581
  Medicare reassignment NPD
• Healthlinc, Inc

  dba HealthLinc - Newton

  • Federally Qualified Health Center (FQHC)
  • Morocco, IN
  • NPI 1568354116
  NPD

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

{
    "created_epoch": "1534204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616457600000",
    "number": "1871073478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "338 E MAPLE ST",
            "city": "GRANVILLE",
            "state": "OH",
            "postal_code": "430231415",
            "telephone_number": "812-267-6311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11660 UPPER GILCHRIST RD",
            "city": "MOUNT VERNON",
            "state": "OH",
            "postal_code": "430509084",
            "telephone_number": "740-399-2200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLINS",
        "first_name": "TRISTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-14",
        "last_updated": "2021-03-23",
        "certification_date": "2021-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019.031815",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12013038A",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "30.026333",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0423186",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300019367",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TRISTA",
            "last_name": "WYMAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mt Vernon Sports and Family Medicine LLC
• Mt. Vernon Hearing Aid Company
• Elvana Muka
• Alicia Lynn Mulkey
• Tori Mullet
• Laura Murnane, MD
• Amy Denise Murnen, M.D.
• Amanda Murphy
• My Urban Clinic, Inc (My Clinic)
• Bobbie Kay Neff, LSW

• Dentist in Mount Vernon, OH
• Providers in Mount Vernon, OH by specialty
• Dentist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.