NPIMap

Organization Active NPI

South Big Horn County Hospital District

Doing business as South Big Horn County Critical Access Hospital

  • Critical Access Hospital
  • Basin, WY
National Provider Identifier
1013919794
Registry record updated Oct 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
Legal business name
SOUTH BIG HORN COUNTY HOSPITAL DISTRICT
Doing business as
South Big Horn County Critical Access Hospital
Practice address
388 South US Hwy 20
Basin, WY 82410-8902
Phone
(307) 568-3311
Fax
(307) 568-2139
NPI assigned
Aug 12, 2005
Last updated
Oct 30, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
SOUTH BIG HORN COUNTY HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 30, 2023

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

Authorized official

Name
Joel Jackson
Title
Chief Executive Officer
Phone
(307) 568-1426

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208D00000X
Medicare Defined Swing Bed Hospital Unit 275N00000X
Critical Access Hospital 282NC0060X 06-139 WY
Critical Access Hospital 282NC0060X Primary

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 names 1

  • South Big Horn County Critical Access Hospital Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1013919794. Details of each certification follow.

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
OtherNon-profit
Enrollment address
388 US Highway 20 S
Basin, WY 82410-8902
Main/Primary Hospital Location

Hospital certification: CCN 53Z301

Legal name
SOUTH BIG HORN COUNTY HOSPITAL DISTRICT
Doing business as
SOUTH BIG HORN COUNTY HOSPITAL
Organization structure
OtherNon-profit
Incorporated
Jul 18, 2008 in WY
Enrollment address
388 US Hwy 20 South
Basin, WY 82410-8902

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
South Big Horn County HospitalCCN 531301 · All quality measures
Type
Critical Access Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Part of
Bonnie Bluejacket Radio

Interoperability endpoints

  • Direct secure messaging: kbonnelphillips@threerivershealth.cernerdirect.com

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
South Big Horn County Hospital District Organization, Basin, WY Operational/Managerial Control Apr 17, 2008
Operational/Managerial Control Jul 18, 2008 100%
Connie Werbelow Individual Corporate OfficerBoard Member Jan 1, 2019
Corporate DirectorBoard Chair Jan 1, 2019
Paul Thur Individual Corporate OfficerBoard Member Nov 20, 2019
Marion a Thompson Individual Corporate OfficerCeo Jan 1, 2023
W-2 Managing EmployeeCeo Jan 1, 2023
Jeff Petty Individual Corporate OfficerBoard Member Feb 2, 2022
Corporate DirectorBoard Member Feb 2, 2022
Tamara Sawyer Individual W-2 Managing EmployeeDirector of Human Resources Nov 20, 2017
Corporate OfficerDirector of Human Resources Nov 1, 2017
W-2 Managing EmployeeDirector of Human Resources Nov 1, 2017
Fred Werner Individual Corporate OfficerBoard Member Jan 1, 2023
Corporate DirectorBoard Member Jan 1, 2023
Janet Evans Individual Corporate OfficerBoard Member Jan 1, 2023
Corporate DirectorBoard Member Jan 1, 2023
Joel Jackson Individual Corporate OfficerCeo May 23, 2023
W-2 Managing EmployeeAd; May 23, 2023
Trudy Craft Individual Corporate DirectorBoard Member Sep 20, 2023

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
South Big Horn County HospitalBasin, WY, CCN 53Z301 Hospital Operational/Managerial Control (100%) Jul 18, 2008
Midway ClinicBasin, WY, CCN 533981 Rural health clinic Operational/Managerial Control (100%) Jun 27, 1995

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 42

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.

View all 42

Affiliated clinicians 32

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 32

NPI Registry JSON

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

{
    "created_epoch": "1123804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698624000000",
    "number": "1013919794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "388 SOUTH US HWY 20",
            "city": "BASIN",
            "state": "WY",
            "postal_code": "824108902",
            "telephone_number": "307-568-3311",
            "fax_number": "307-568-2139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "388 SOUTH US HWY 20",
            "city": "BASIN",
            "state": "WY",
            "postal_code": "824108902",
            "telephone_number": "307-568-3311",
            "fax_number": "307-568-2139"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH BIG HORN COUNTY HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTH BIG HORN COUNTY HOSPITAL DISTRICT",
        "enumeration_date": "2005-08-12",
        "last_updated": "2023-10-30",
        "certification_date": "2023-10-30",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "JOEL",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "307-568-1426"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "WY",
            "license": "06-139",
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Big Horn County Critical Access Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "South Big Horn County Critical Access Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Basin, WY

Sources for this page

Verify at the official NPI Registry.