NPIMap

Individual provider Active NPI

Douglas W Edgren, MD

  • Family Medicine Physician
  • Cheyenne, WY
National Provider Identifier
1033145164
Registry record updated Jun 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5108A Issued in WY
Practice address
1331 Prairie Ave Ste 1
Cheyenne, WY 82009-4867
Phone
(307) 632-0728
NPI assigned
Jun 23, 2006
Last updated
Jun 8, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 8, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036091285 IL
Family Medicine Physician 207Q00000X 5108A WY Primary

Addresses

Primary practice location

1331 Prairie Ave Ste 1
Cheyenne, WY 82009-4867

Mailing address

1331 Prairie Ave Ste 1
Cheyenne, WY 82009-4867
Phone (307) 632-0728

Other names 1

  • William Edgren Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150205001773 WY Practitioner - General Practice 6608943006 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Practice
Education
University of South Florida College of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Babson and Associates Primary Care PCGroup PAC ID 0345223343, 6 clinicians

Practice addresses (Care Compare)

1331 Prairie Ave
Suite 1
Cheyenne, WY 82009-4867
Phone (307) 632-0728

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions33
Removal of nail tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy12

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036091285ILMDFamily Medicine Physician
5108AWYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Granite SNF Operations, LLC Past Accepting new patients
Cater Chiropractic Clinic PC PastSince Aug 1, 2008 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: douglas.edgren.1@27166.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 9

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

NPI Registry JSON

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

{
    "created_epoch": "1151020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623110400000",
    "number": "1033145164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1331 PRAIRIE AVE STE 1",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820094867",
            "telephone_number": "307-632-0728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1331 PRAIRIE AVE STE 1",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820094867",
            "telephone_number": "307-632-0728"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDGREN",
        "first_name": "DOUGLAS",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-23",
        "last_updated": "2021-06-08",
        "certification_date": "2021-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036091285",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WY",
            "license": "5108A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "WILLIAM",
            "last_name": "EDGREN",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Cheyenne, WY

Sources for this page

Verify at the official NPI Registry.