Individual provider Active NPI

Andrew Nielsen, PT, DPT

  • Orthopedic Physical Therapist
  • Gillette, WY
National Provider Identifier
1053806703
Registry record updated Jul 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
Practice address
1103 E Boxelder Rd Ste U
Gillette, WY 82718
Phone
(307) 686-8177
Fax
(307) 686-9484
NPI assigned
Jun 26, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Physical Therapist 2251X0800X WY Primary

Addresses

Primary practice location

1103 E Boxelder Rd Ste U
Gillette, WY 82718

Mailing address

600 Running W Dr
Gillette, WY 82718-2017
Phone (308) 530-7625

Other practice location 1

600 Running W Dr
Gillette, WY 82718-2017
Phone (308) 530-7625

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180920000867 WY Practitioner - Physical Therapist in Private Practice 0042561615 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
212 Degrees LLCGroup PAC ID 3072648468, 12 clinicians

Practice addresses (Care Compare)

1103 E Boxelder Rd
Suite U
Gillette, WY 82718-5582
Phone (307) 686-8177

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1657WYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
212 Degrees, LLC CurrentSince Jul 5, 2018 Accepting new patients

Locations

1103 E Boxelder Rd
Ste U
Gillette, WY 82718
Phone (307) 363-5801

219 W Main St
Newcastle, WY 82701
Phone (307) 363-5930

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1529971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531872000000",
    "number": "1053806703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 RUNNING W DR",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827182017",
            "telephone_number": "308-530-7625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1103 E BOXELDER RD STE U",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "82718",
            "telephone_number": "307-686-8177",
            "fax_number": "307-686-9484"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "600 Running W Dr",
            "address_purpose": "LOCATION",
            "city": "Gillette",
            "state": "WY",
            "postal_code": "827182017",
            "country_code": "US",
            "telephone_number": "308-530-7625",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NIELSEN",
        "first_name": "ANDREW",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-26",
        "last_updated": "2018-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "WY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gillette, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.