TRI-STATE MEDICAL GROUP, INC (NPI# 1508001538) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508001538 |
| Entity Type | Organization |
| Organization Name | TRI-STATE MEDICAL GROUP, INC |
| Other Organization Name | CONVENIENT CARE CENTER-BEAVER |
| Practice Address |
274 3rd St Suite 100 Beaver PA 15009-2333 |
| Practice Telephone | 7247742942 |
| Practice Fax Number | 7247742942 |
| Mailing Telephone | 7247742942 |
| Mailing Fax Number | 7247742942 |
| Enumeration Date | 2008-12-04 |
| Last Update Date | 2008-12-04 |
| Authorized Official Name | MR. NORMAN F. MITRY (PRESIDENT & CEO) |
| Authorized Official Telephone | 7247734776 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians | ||
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| N | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians | ||
| N | 363A00000X | Physician Assistant | Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363LP0200X |
Nurse Practitioner Specialization: Pediatrics |
Physician Assistants & Advanced Practice Nursing Providers | ||
| N | 363LP2300X |
Nurse Practitioner Specialization: Primary Care |
Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PA | 1007289980010 | 05 | |
| PA | 0015486320010 | 05 | |
| PA | 0015654460023 | 05 | |
| OH | 0202677 | 05 |
| Other Name | Type Code |
|---|---|
| Convenient Care Center-Beaver | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841429099 | Tri-state Medical Group, Inc | Family Medicine | 1185 Freedom Rd, Suite B106, Cranberry Twp, PA 16066-4913 | 2009-07-09 |
| 1396076881 | Tri-state Medical Group, Inc | Family Medicine | 918 3rd Ave, Beaver Falls, PA 15010-4613 | 2010-01-22 |
| 1851543607 | Tri-state Medical Group, Inc | Surgery | 1520 3rd Ave, New Brighton, PA 15066-2204 | 2008-10-10 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Iowa Business Entities | TRI-STATE MEDICAL GROUP, INC. | 1600 Morgan Street, Keokuk, IA 52632 |
| Street Address |
274 3RD ST SUITE 100 |
| City | BEAVER |
| State | PA |
| Zip Code | 15009-2333 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972599082 | Robert M Meuser | Surgery | 274 3rd St, Beaver, PA 15009-2333 | 2005-09-23 |
| 1396216727 | Heritage Valley Medical Group, Inc. | Surgery | 274 3rd St, Beaver, PA 15009-2333 | 2018-12-11 |
| 1407219173 | Association of Specialty Physicians, Inc. | Urology | 274 3rd St, Beaver, PA 15009-2333 | 2016-03-31 |
| 1386907103 | Natalie Brahm | Physician Assistant | 274 3rd St, Beaver, PA 15009-2333 | 2012-06-18 |
| 1710206107 | Colleen Gilliland | Nurse Practitioner | 274 3rd St, Suite 100, Beaver, PA 15009-2333 | 2010-05-25 |
| 1366779985 | Marie T Winter | Nurse Practitioner | 274 3rd St, Suite A, Beaver, PA 15009-2333 | 2009-11-04 |
| 1497999114 | Marla J Slayton | Nurse Practitioner | 274 3rd St, Beaver, PA 15009-2333 | 2009-04-24 |
| 1699858910 | R. Bradley Hayward | Surgery | 274 3rd St, Beaver, PA 15009-2333 | 2006-10-23 |
| 1003873241 | Jane Gagne | Family Medicine | 274 3rd St, Suite 100, Beaver, PA 15009-2333 | 2006-05-01 |
| 1699738435 | Annmarie Ray | Internal Medicine | 274 3rd St, Suite 3, Beaver, PA 15009-2333 | 2006-04-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548734494 | Renee Thomas | Registered Nurse | 659 3rd Street, Upper Suite, Beaver, PA 15009 | 2019-01-14 |
| 1275048654 | Dominic J. Deluigi Phd LLC | Psychologist | 500 Market St., Sutei 204b, Beaver, PA 15009 | 2017-12-07 |
| 1861845208 | Gary Koch | Psychologist | 500 Market St Ste 204b, Beaver, PA 15009 | 2016-07-21 |
| 1326367616 | Merakey Pennsylvania | Community/Behavioral Health | 148 Theodore Drive, Chippewa, PA 15009 | 2010-05-26 |
| 1912237215 | Sandra L. Mckeel | Counselor | 697 State Street, Vanport, PA 15009 | 2010-01-08 |
| 1790019438 | Tri-state Medical Group, Inc. | Physical Medicine & Rehabilitation | 1030 Beaner Hollow Road, Beaver Medical Commons, Beaver, PA 15009 | 2009-09-29 |
| 1700040730 | Marie R Brauch | Counselor | 697 State St, #5, Beaver, PA 15009 | 2008-07-18 |
| 1932376696 | Justin Dosch | Emergency Medicine | 1000 Dutch Run Rd, Beaver, PA 15009 | 2008-05-13 |
| 1023280492 | Paul Michael Kuzma Jr Md | Ophthalmology | 628 Market Street, Bridgewater, PA 15009 | 2008-03-26 |
| 1881877868 | Jaime Michelle Kinkead | Social Worker | 160 Third Street, Beaver, PA 15009 | 2007-12-12 |
| Find all providers in zip 15009 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114342243 | Anchor Medical LLC | Nurse Practitioner | 1196 Airport Road, Beaver, WV 25813-9422 | 2014-02-26 |
| 1629271424 | Kristal Shay Dailey | Nurse Practitioner | 1170 Tile Mill Rd, Beaver, OH 45613-9435 | 2007-06-08 |
| 1518073907 | Sherry L Duvall | Nurse Practitioner | 134 Medical Place, Airport Industrial Park, Commerce Drive, Beaver, WV 25813 | 2006-08-21 |
| 1003883166 | Jennifer Ruth Bobish | Nurse Practitioner | 350 3rd St, Beaver, PA 15009-2261 | 2006-03-07 |
| 1326045980 | Wendy S Merulli | Nurse Practitioner | 1201 3rd St, Beaver, PA 15009-2530 | 2005-06-28 |
| 1740750561 | Joan Yardley | Nurse Practitioner | 1059 N 100 W, Beaver, UT 84713-7758 | 2018-12-05 |
| 1336683960 | Jenefer L Barry | Nurse Practitioner | 250 College Ave, Beaver, PA 15009-2706 | 2016-12-16 |
| 1700275831 | Robert C Knapp Md LLC | Nurse Practitioner | 701 Sharon Rd, Suite 4, Beaver, PA 15009-3147 | 2015-01-13 |
| 1134425333 | Jennifer Lentz | Nurse Practitioner | 1000 Dutch Ridge Rd, Beaver, PA 15009-9727 | 2011-02-04 |
| 1710206107 | Colleen Gilliland | Nurse Practitioner | 274 3rd St, Suite 100, Beaver, PA 15009-2333 | 2010-05-25 |
| Find all providers in BEAVER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.