Edward Callaghan, M.D.

Key facts

NPI

1013969211

Entity type

Individual (NPI type 1)

Primary specialty

Anatomic Pathology & Clinical Pathology Physician 207ZP0102X

License

11692A (WY)

Practice address

625 E Broadway Ave
Jackson, WY 83001-8642

Phone

(307) 733-6418

NPI assigned

May 16, 2006

Sex

Male

Sole proprietor

No

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Memorial Hospital of Sweetwater County Critical Access Hospital · Rock Springs, WY · NPI 1558361949
  Medicare reassignment NPD WY
• Teton Pathology, PC Clinical Medical Laboratory · Jackson, WY · NPI 1780027953
  Medicare reassignment WY
• Weland Clinical Laboratories, P.C. Clinical Medical Laboratory · Cedar Rapids, IA · NPI 1235121450
  NPD (past)

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Riverton Memorial Hospital LLC Rural Acute Care Hospital · Lander, WY · NPI 1245337286
  Care Compare affiliation Hospital
• Teton County Hospital District General Acute Care Hospital · Jackson, WY · NPI 1801835475
  Care Compare affiliation Hospital

Medicare Care Compare profile

Specialty

Pathology

Education

Virginia Commonwealth University, School of Medicine, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Johns Medical Center Hospital · Jackson, WY · CCN 530015
• Sagewest Health Care Hospital · Riverton, WY · CCN 530008

Merit-based Incentive Payment System (MIPS)

Final score

0 of 100 (individual)

Quality

0

Improvement activities

0

Cost

0

Medicare participation

Medicare fee-for-service enrollment

Enrolled in WY

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 5, 2021.

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609804800000",
    "number": "1013969211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1911 1ST AVE SE",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "524025320",
            "telephone_number": "319-366-1503",
            "fax_number": "319-366-6976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 E BROADWAY AVE",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830018642",
            "telephone_number": "307-733-6418"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1911 1ST AVE SE",
            "address_purpose": "LOCATION",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "524025320",
            "country_code": "US",
            "telephone_number": "319-366-1503",
            "fax_number": "319-366-6976",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CALLAGHAN",
        "first_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-16",
        "last_updated": "2021-01-05",
        "certification_date": "2021-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "MT",
            "license": "8556",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "WY",
            "license": "11692A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0000013515",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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