NPIMap

Organization Active NPI

Tri-State Centers for Sight,Inc

  • Ophthalmology Physician
  • Crestview Hills, KY
National Provider Identifier
1982008611
Registry record updated Feb 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
TRI-STATE CENTERS FOR SIGHT,INC
Practice address
500 Thomas More Pkwy
Crestview Hills, KY 41017-3454
Phone
(859) 341-4525
Fax
(859) 341-4993
NPI assigned
Oct 9, 2014
Last updated
Feb 12, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2024

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

Authorized official

Name
Candice B Davis
Title
Chief Revenue Cycle Officer
Phone
(916) 990-7590

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X Primary

Addresses

Primary practice location

500 Thomas More Pkwy
Crestview Hills, KY 41017-3454

Mailing address

2865 Chancellor Dr
Suite 215
Crestview Hills, KY 41017-3912
Phone (859) 581-7120

Other identifiers 3

IdentifierTypeStateIssuer
65925760MedicaidKY
77903425MedicaidKY
0111751MedicaidOH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040219000102 KY Part B Supplier - Clinic/Group Practice 7113812090 Receives reassigned benefits from 31 practitioners
17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Mount Sterling, KY; Versailles, KY; Paintsville, KY; Morehead, KY; Middlesboro, KY; Maysville, KY; Lexington, KY; London, KY…

Other NPIs on the same Medicare enrollment 17

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 17

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
18D2089729Tri-State Centers for Sight500 Thomas Moore Parkway Ste 1, Crestview Hills, KY 41017Certificate of waiverJan 6, 2027

National Provider Directory

National Provider Directory
Tax ID family
Tri-State Centers for Sight Inc27 organizations share this tax ID, including this one

Other organizations with this tax ID 26

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

View all 26

Practitioners & affiliated clinicians

Practitioners 4

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": "1412812800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707696000000",
    "number": "1982008611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2865 CHANCELLOR DR",
            "address_2": "SUITE 215",
            "city": "CRESTVIEW HILLS",
            "state": "KY",
            "postal_code": "410173912",
            "telephone_number": "859-581-7120",
            "fax_number": "859-581-7207"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 THOMAS MORE PKWY",
            "city": "CRESTVIEW HILLS",
            "state": "KY",
            "postal_code": "410173454",
            "telephone_number": "859-341-4525",
            "fax_number": "859-341-4993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-STATE CENTERS FOR SIGHT,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-09",
        "last_updated": "2024-02-12",
        "certification_date": "2024-02-12",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "CANDICE",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CHIEF REVENUE CYCLE OFFICER",
        "authorized_official_telephone_number": "916-990-7590"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65925760",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "77903425",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0111751",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Crestview Hills, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2024; 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.