Stanford T Israelsen, MD

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

9750A Issued in WY

Practice address

508 Stocktrail Ave
Suite a
Gillette, WY 82716-3582

Phone

(307) 686-1413

NPI assigned

Aug 8, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Orthopedic Surgery

Education

Baylor College of Medicine, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Campbell County Hospital DistrictGroup PAC ID 2860392529, 128 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Campbell County Memorial Hospital Home Health Home health agency, Gillette, WY, CCN 537035
• Campbell County Health Hospital, Gillette, WY, CCN 530002
• Weston County Health Services Hospital, Newcastle, WY, CCN 531303
• Sheridan Memorial Hospital Hospital, Sheridan, WY, CCN 530006

Merit-based Incentive Payment System (MIPS)

Final score

90.16 of 100Reported as individual

Quality

82.1

Promoting interoperability

100

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Campbell County Hospital District

  • Internal Medicine Physician
  • Gillette, WY
  • NPI 1710098868
  Medicare reassignment Care Compare group NPD
• Campbell County Hospital District

  • Orthopaedic Surgery Physician
  • Gillette, WY
  • NPI 1386875193
  NPD
• Campbell County Hospital District

  • Community/Retail Pharmacy
  • Gillette, WY
  • NPI 1992874218
  NPD
• Powder River Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Gillette, WY
  • NPI 1063040731
  NPD
• Campbell County Hospital District

  • Skilled Nursing Facility
  • Gillette, WY
  • NPI 1376620989
  NPD (past)
• Frances Mahon Deaconess Hospital

  • Critical Access Hospital
  • Glasgow, MT
  • NPI 1689685323
  NPD (past)

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

• Campbell County Hospital District

  • Home Health Agency
  • Gillette, WY
  • NPI 1265547350
  Care Compare affiliation
• Campbell County Hospital District

  • General Acute Care Hospital
  • Gillette, WY
  • NPI 1487638417
  Care Compare affiliation
• Campbell County Hospital District

  • Ambulatory Surgical Clinic/Center
  • Gillette, WY
  • NPI 1780738153

  Hospital

  Care Compare affiliation
• Memorial Hospital of Sheridan County

  • General Acute Care Hospital
  • Sheridan, WY
  • NPI 1487707188
  Care Compare affiliation
• Weston County Hospital District

  • Rural Acute Care Hospital
  • Newcastle, WY
  • NPI 1154402972
  Care Compare affiliation

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

{
    "created_epoch": "1218153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407888000000",
    "number": "1093961179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "508 STOCKTRAIL AVE",
            "address_2": "SUITE A",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827163582",
            "telephone_number": "307-686-1413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "508 STOCKTRAIL AVE",
            "address_2": "SUITE A",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827163582",
            "telephone_number": "307-686-1413"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ISRAELSEN",
        "first_name": "STANFORD",
        "middle_name": "T",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-08",
        "last_updated": "2014-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "WY",
            "license": "9750A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jamie S Hurich, PPC
• Timothy Alan Hursh, M.D.
• Mariah Igo
• Robert Joseph Innes, PH.D.
• Innovative Therapy Solutions, LLC
• Lisa Jackson-Eldridge, MSW
• Amber Lauren Jackson-Jordan, R.N.
• Brenda Lavonne Jacob, MS, CCDC III, LAT
• Kerena Luann Jacquot
• James J Naramore

• Orthopaedic Surgery Physician in Gillette, WY
• Providers in Gillette, WY by specialty
• Orthopaedic Surgery Physician in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.