South Big Horn County Hospital District
Organization Active NPI Critical Access Hospital · Basin, WY
NPI 1013919794 · NPPES record last updated Oct 30, 2023
Key facts
- NPI
- 1013919794
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Critical Access Hospital 282NC0060X
- Legal business name
- SOUTH BIG HORN COUNTY HOSPITAL DISTRICT
- Practice address
- 388 South US Hwy 20
Basin, WY 82410-8902 - Phone
- (307) 568-3311
- Fax
- (307) 568-2139
- NPI assigned
- Aug 12, 2005
- Organization subpart
- Yes
- Parent organization (as reported)
- SOUTH BIG HORN COUNTY HOSPITAL DISTRICT
Authorized official
- Name
- Joel Jackson
- Title
- Chief Executive Officer
- Phone
- (307) 568-1426
Owners & managing parties with NPI records 2
Owned or controlled facilities with NPI records 2
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 2
Related certifications (CCN) 2
Facilities with the same owner 2
Practitioners 42
-
Michael Allen Bellamy, D.O.
-
Bradley J North, DO
-
Charles S Polley, MD
-
Tammy Lynn Ballant, ARNP
-
Paul F Hunt, M.D.
-
Stacy Ann Martin, MD
-
Mark Raine, MD
-
Filip Turcer, MD
-
Kelly E Christensen, M.D.
-
Adam C Crawford, RN
-
Mary Freund, NP
-
Stephen R Katz, CRNA
-
Shawna Martin, CRNA
-
Daniel F. Alderman, M.D.
-
Douglas Bell, MD
Affiliated clinicians 32
-
Julie Agee, FNP
-
Benjamin Edward Beasley, M.D.
-
Michael Allen Bellamy, D.O.
-
Jimmie G Biles Jr., M.D.
-
Carletta Collins, MD
-
Craig James Edwards, PA-C
-
Judd Larowe, MD
-
David Mills, MD
-
Bradley J North, DO
-
Charles S Polley, MD
-
Angela Marie Redder, PA-C
-
Heather A Sanders, P.A.
-
Jeffrey Lee Scott, D.O.
-
Makyela Dawn Sorensen, PA-C
-
Courtney Spence, DO
-
Gregory S Stewart, M.D.
-
Tiffany Jane Tanner, PA-C
-
Stacy Ann Martin, MD
Medicare Care Compare: Hospital
- Listed as
- South Big Horn County Hospital
- Type
- Critical Access Hospitals
- Ownership
- Government - Hospital District or Authority
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in WY
Hospital certification: CCN 531301
- Legal name
- SOUTH BIG HORN COUNTY HOSPITAL DISTRICT
- Doing business as
- SOUTH BIG HORN COUNTY HOSPITAL
- Certification status
- Active
- Provider type (POS)
- Hospital – Critical access hospital
- Participating since
- Jan 6, 2001
- Last certification
- Mar 10, 2022
- Beds
- 10
- Ownership / control type
- Hospital district or authority
- Organization structure
- Other · Non-profit
- Enrollment address
- 388 US Highway 20 S
Basin, WY 82410-8902
Hospital certification: CCN 53Z301
- Legal name
- SOUTH BIG HORN COUNTY HOSPITAL DISTRICT
- Doing business as
- SOUTH BIG HORN COUNTY HOSPITAL
- Organization structure
- Other · Non-profit
- Incorporated
- Jul 18, 2008 in WY
- Enrollment address
- 388 US Hwy 20 South
Basin, WY 82410-8902
All disclosed owners & managing parties 10
| Name | Role | Since | Share |
|---|---|---|---|
| South Big Horn County Hospital District |
Operational/Managerial Control | Apr 17, 2008 | |
| Operational/Managerial Control | Jul 18, 2008 | 100% | |
| Connie Werbelow |
Corporate Officer |
Jan 1, 2019 | |
| Corporate Director |
Jan 1, 2019 | ||
| Paul Thur |
Corporate Officer |
Nov 20, 2019 | |
| Marion a Thompson |
Corporate Officer |
Jan 1, 2023 | |
| W-2 Managing Employee |
Jan 1, 2023 | ||
| Jeff Petty |
Corporate Officer |
Feb 2, 2022 | |
| Corporate Director |
Feb 2, 2022 | ||
| Tamara Sawyer |
W-2 Managing Employee |
Nov 20, 2017 | |
| Corporate Officer |
Nov 1, 2017 | ||
| W-2 Managing Employee |
Nov 1, 2017 | ||
| Fred Werner |
Corporate Officer |
Jan 1, 2023 | |
| Corporate Director |
Jan 1, 2023 | ||
| Janet Evans |
Corporate Officer |
Jan 1, 2023 | |
| Corporate Director |
Jan 1, 2023 | ||
| Joel Jackson |
Corporate Officer |
May 23, 2023 | |
| W-2 Managing Employee |
May 23, 2023 | ||
| Trudy Craft |
Corporate Director |
Sep 20, 2023 |
All facility ownership & control disclosures 2
| Facility | Type | Role | Since |
|---|---|---|---|
| South Big Horn County Hospital |
Hospital | Operational/Managerial Control (100%) | Jul 18, 2008 |
| Midway Clinic |
Rural health clinic | Operational/Managerial Control (100%) | Jun 27, 1995 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080909000055 | WY | Part a Provider - Critical Access Hospital | 1254314107 |
Receives reassigned benefits from 42 practitioners Practice locations: Basin, WY |
| O20080909000078 | WY | Part a Provider - Critical Access Hospital | 1254314107 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Basin, WY |
| O20171128000926 | WY | Part B Supplier - Clinic/Group Practice | 1254314107 |
Receives reassigned benefits from 29 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Basin, WY |
National Provider Directory
- Part of
- South Big Horn
Interoperability endpoints
- kbonnelphillips@threerivershealth.cernerdirect.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician |
208D00000X | |||
| Medicare Defined Swing Bed Hospital Unit | 275N00000X | |||
| Critical Access Hospital | 282NC0060X | 06-139 | WY | |
| Critical Access Hospital | 282NC0060X | Yes |
Addresses
Primary practice location
388 South US Hwy 20
Basin, WY 82410-8902
Mailing address
388 South US Hwy 20
Basin, WY 82410-8902
Phone (307) 568-3311
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 116049400 | Medicaid | WY | |
| 7385 | Other | WY | BLUECROSS |
| 007385 | Other | WY | BLUE SHIELD |
| 116049401 | Medicaid | WY |
Other names
- South Big Horn County Critical Access Hospital
Other providers in Basin, WY
- Andrew L Roberts
- Carissa Rohrbach
- Jacob R Shaw
- Jesi Skretteberg
- Christine Mae Smith
- South Big Horn County Hospital District
- South Big Horn County Hospital District
- South Big Horn County Hospital District
- Steven Staab
- State of Wyoming
All providers in Basin, WY · Critical Access Hospital in Wyoming
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 30, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.