Elevation Medical Imaging Gillette

Primary specialty

Radiology Clinic/CenterTaxonomy code 261QR0200X

Legal business name

ELEVATION MEDICAL IMAGING GILLETTE

Practice address

913 E Boxelder Rd
Gillette, WY 82718

Phone

(307) 682-1779

Fax

(307) 682-1745

NPI assigned

Sep 23, 2021

Last updated

Apr 24, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Shaun Andrikopoulos

Title

Partner

Phone

(307) 682-1779

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WY

Enrollment records 1

Locations

Practitioners 1

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.

• John McCormac, M.D.

  • Diagnostic Radiology Physician
  • Independence, OH
  • NPI 1235131996
  NPD

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

{
    "created_epoch": "1632355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682294400000",
    "number": "1003587692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 736",
            "city": "WHEAT RIDGE",
            "state": "CO",
            "postal_code": "800340736",
            "telephone_number": "307-218-8223",
            "fax_number": "317-218-8224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "913 E BOXELDER RD",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "82718",
            "telephone_number": "307-682-1779",
            "fax_number": "307-682-1745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELEVATION MEDICAL IMAGING GILLETTE",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-23",
        "last_updated": "2023-04-24",
        "certification_date": "2023-04-24",
        "status": "A",
        "authorized_official_last_name": "ANDRIKOPOULOS",
        "authorized_official_first_name": "SHAUN",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "307-682-1779"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca Edwards, CRNA
• Suzan Tamesha Edwards, RN
• William Pell Egbert, MD
• Alphonse Eid
• Ekstroms Nursing, LLC
• Employment Testing Services
• Deborah A Engel, PHARM D
• Nita R. Engineer, MD
• Brooke L England, PSY.D.
• Jodi Ensminger

• Radiology Clinic/Center in Gillette, WY
• Providers in Gillette, WY by specialty
• Radiology Clinic/Center in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.