Individual provider Active NPI

James William Wyssmann, PHD

  • Clinical Psychologist
  • Sheridan, WY
National Provider Identifier
1063695419
Registry record updated Feb 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
403 Issued in WY
Practice address
1949 Sugarland Dr Ste 218
Sheridan, WY 82801-5765
Phone
(307) 752-0677
Fax
(307) 674-1825
NPI assigned
Dec 7, 2007
Last updated
Feb 8, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 8, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 403 WY Primary

Addresses

Primary practice location

1949 Sugarland Dr Ste 218
Sheridan, WY 82801-5765

Mailing address

PO Box 6692
Sheridan, WY 82801
Phone (307) 752-0677

Other identifiers 1

IdentifierTypeStateIssuer
125548700MedicaidWY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150723007041 WY Practitioner - Psychologist Billing Independently 2961715776 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Life Strategy CenterGroup PAC ID 2860710472, 2 clinicians

Practice addresses (Care Compare)

1949 Sugarland Dr
Suite 218
Sheridan, WY 82801-5765
Phone (307) 674-8686

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
403WYMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Wyssmann Psychological & Counseling, LLC CurrentSince Dec 12, 2013 Accepting new patients
Life Strategy Center Clinical CurrentSince Feb 1, 2017 Accepting new patients
Holistic Pain Management of Wyoming, LLC Past Accepting new patients

Locations

1949 Sugarland Dr
Ste 218
Sheridan, WY 82801
Phone (307) 674-8686

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.

NPI Registry JSON

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

{
    "created_epoch": "1196985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612742400000",
    "number": "1063695419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6692",
            "city": "SHERIDAN",
            "state": "WY",
            "postal_code": "82801",
            "telephone_number": "307-752-0677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1949 SUGARLAND DR STE 218",
            "city": "SHERIDAN",
            "state": "WY",
            "postal_code": "828015765",
            "telephone_number": "307-752-0677",
            "fax_number": "307-674-1825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYSSMANN",
        "first_name": "JAMES",
        "middle_name": "WILLIAM",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-12-07",
        "last_updated": "2021-02-08",
        "certification_date": "2021-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WY",
            "license": "403",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "125548700",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sheridan, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2021; 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.