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TRI-STATE VASCULAR GROUP, PLLC
NPI 1366993818
Surgery - Vascular Surgery in Needles, CA

Active since October 19, 2016
1401 BAILEY AVE BLDG A, NEEDLES, CA 92363(960) 590-0155(760) 326-7170 Get Directions Write a Review

NPPES record last updated: April 8, 2024. Verified against the NPPES registry weekly; last sync: November 08, 2026.

Record update history: Apr 8, 2024, Feb 19, 2020, Oct 19, 2016 (3 updates tracked since 2016).

About Tri-state Vascular Group, Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TRI-STATE VASCULAR GROUP, PLLC (NPI 1366993818) is a healthcare organization registered as a vascular surgery in Needles, California and active in the NPI registry since October 2016. The organization lists Wantzy Cooper, Owner/member Manager, as its authorized official.

NPPES Registry Identity

NPI1366993818
Entity TypeOrganization
Primary Taxonomy2086S0129X
Legal Business NameTRI-STATE VASCULAR GROUP, PLLC
Location Address1401 BAILEY AVE BLDG ANeedles, CA 92363-3103
Mailing AddressPo Box 9893Fort Mohave, AZ 86427-9893 · (928) 788-4944 · Fax (928) 788-4949
Phone(960) 590-0155
Fax(760) 326-7170
Organization SubpartNo
Authorized OfficialWantzy CooperOwner/member Manager · (760) 590-0155
Enumeration DateOctober 19, 2016
Last NPPES UpdateApril 8, 20243 updates tracked since enumeration
NPPES CertifiedApril 8, 2024
✔ NPI 1366993818 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtySurgery · Vascular SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code2086S0129X
Definition
A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart.
Also ListedGeneral PracticeTaxonomy 208D00000X
1401 BAILEY AVE BLDG A, Needles, CA 92363
Open in Google Maps ↗

Other Identifiers 2

OtherP20421635AZ · Corporation Registration Number
Medicaid205332AZ

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Tri-state Vascular Group, Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Tri-State Vascular Group, PLLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Wantzy Cooper, D.O.
Vascular Surgery
NPI 1942383393
1401 BAILEY AVE BLDG 1
Needles, CA 92363
(760) 590-0155
✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Tri-State Vascular Group, PLLC's NPI number?

The NPI number for Tri-State Vascular Group, PLLC is 1366993818. It was assigned to this organization in the NPPES registry on October 19, 2016.

Where is Tri-State Vascular Group, PLLC located?

Tri-State Vascular Group, PLLC is located at 1401 Bailey Ave Bldg A, Needles, CA 92363. The listed phone number is (960) 590-0155.

What is Tri-State Vascular Group, PLLC's specialty?

The primary specialty registered for this NPI is Surgery, specializing in Vascular Surgery, with taxonomy code 2086S0129X.

Is Tri-State Vascular Group, PLLC enrolled in Medicare?

Yes. Tri-State Vascular Group, PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Tri-State Vascular Group, PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Vascular Surgery) reassigns their Medicare billing to Tri-State Vascular Group, PLLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Tri-State Vascular Group, PLLC was last updated on April 8, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.