Active NPI
Andrew Nielsen, PT, DPT
- Orthopedic Physical Therapist
- Gillette, WY
National Provider Identifier
1053806703
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopedic Physical Therapist
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
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
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
| License | State | Type | Specialty |
|---|---|---|---|
| 1657 | WY | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| 212 Degrees, LLC | Current | 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.