TRI-STATE FAMILY HEALTHCARE
NPI 1649370719
Clinic/Center - Rural Health in Middlesboro, KY
About Tri-state Family Healthcare NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
TRI-STATE FAMILY HEALTHCARE (NPI 1649370719) is a healthcare organization registered as a rural health in Middlesboro, Kentucky and active in the NPI registry since September 2006. The organization holds a CLIA Waiver certificate valid through June 17, 2027 and lists Larry B Roark, Nurse Practitioner/owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
Other Names 1
Accepted Insurance
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 Family Healthcare is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
5Medicare enrollment records show 5 clinicians reassign Medicare billing to Tri-State Family Healthcare, which bills Medicare for the services they deliver. Of these, 3 practice within 10 miles. They are listed nearest first.
Clinicians, nearest first (5)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 18D1011610
Tri State Medical Clinic · Middlesboro, KYFrequently 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 Medical Clinic Inc's NPI number?
The NPI number for Tri State Medical Clinic Inc is 1649370719. It was assigned to this organization in the NPPES registry on September 25, 2006. The provider is doing business as Tri-State Family Healthcare.
Where is Tri State Medical Clinic Inc located?
Tri State Medical Clinic Inc is located at 3503 Cumberland Ave, Middlesboro, KY 40965. The listed phone number is (606) 242-3100.
What is Tri State Medical Clinic Inc's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Rural Health, with taxonomy code 261QR1300X.
Is Tri State Medical Clinic Inc enrolled in Medicare?
Yes. Tri State Medical Clinic Inc is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Tri State Medical Clinic Inc?
According to the CMS Revalidation Reassignment List (October 2026 release), 5 clinicians, all in Nurse Practitioner, reassign their Medicare billing to Tri State Medical Clinic Inc. 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. Of these, 3 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Tri State Medical Clinic Inc hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 18D1011610) is associated with this NPI, valid through June 17, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Tri State Medical Clinic Inc accept?
Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter of Tennessee and Anthem Blue Cross and Blue Shield list Tri State Medical Clinic Inc as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Tri State Medical Clinic Inc was last updated on January 31, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.
# Tri-State Family Healthcare · NPI 1649370719
Rural Health organization in Middlesboro, Kentucky. Organization record, active in the CMS NPPES registry since September 25, 2006.
## Identity
- **NPI:** 1649370719 (Entity type: Organization)
- **Enumerated:** September 25, 2006
- **Primary specialty:** Clinic/Center - Rural Health · taxonomy 261QR1300X
- **Legal business name:** Tri State Medical Clinic Inc
- **Organization subpart:** No
- **Authorized official:** Larry Roark, NURSE PRACTITIONER/OWNER
## Practice location
- **Address:** 3503 CUMBERLAND AVE, Middlesboro, KY 40965-2611
- **Phone:** (606) 242-3100 · **Fax:** (606) 242-3984
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 5 clinicians (Nurse Practitioner) reassign Medicare billing to this organization (form CMS-855R); 3 practice within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** January 31, 2020
- **CLIA laboratory certificates:** 1 on file
---
Source: [NPI Profile](https://npiprofile.com/npi/1649370719) · Data from the CMS NPPES public registry.