NPIMap

Organization Active NPI

Crook County Medical Services District

  • Nursing Care Agency
  • Sundance, WY
National Provider Identifier
1114086402
Registry record updated Sep 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Care AgencyTaxonomy code 251J00000X
Legal business name
CROOK COUNTY MEDICAL SERVICES DISTRICT
Practice address
713 Oak Street
Sundance, WY 82729-0517
Phone
(307) 283-3501
Fax
(307) 283-2255
NPI assigned
Dec 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2020

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

Authorized official

Name
Micki Dahne Lyons, DNP
Title
Ceo
Phone
(307) 283-3501

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Care Agency 251J00000X Primary
Long Term Care Hospital 282E00000X 07-105 WY
Skilled Nursing Facility 314000000X
Inpatient Hospice 315D00000X
Respite Care 385H00000X

Addresses

Primary practice location

713 Oak Street
Sundance, WY 82729-0517

Mailing address

PO Box 517
713 Oak Street
Sundance, WY 82729-0517
Phone (307) 283-3501

Other identifiers 3

IdentifierTypeStateIssuer
106168201MedicaidWY
106168205MedicaidWY
106168210MedicaidWY

Other names 1

  • Crook County Nursing Facility Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100824001188 WY Part A Provider - Skilled Nursing Facility 9234032483 Practice locations: Sundance, WY

Skilled nursing facility certification: CCN 535029

Legal name
CROOK COUNTY MEDICAL SERVICES DISTRICT
Doing business as
CROOK COUNTY MEDICAL SERVICES DISTRICT LONG TERM CARE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Dec 31, 1986
Last certification
May 9, 2024
Beds
32
Ownership / control type
Nonprofit Corporation
Organization structure
CorporationNon-profit
Enrollment address
713 E Oak St
Sundance, WY 82729-5172
Nursing home name
CROOK COUNTY MEDICAL SERVICES DISTRICT LONG TERM CARE

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
Crook County Medical Services District Long Term CCCN 535029
Overall star rating
2 of 5
Health inspections
3 of 5
Staffing
4 of 5
Quality measures
1 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Dec 31, 1986
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
3229.8 residents per day on average
Penalties (3 years)
1Fines totaling $8,981

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Crook Co Memorial Hosp6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Donna Marlene Edwards Individual Operational/Managerial Control Nov 25, 2024
Adp of the SNF Nov 25, 2024
Micki D Lyons Individual Operational/Managerial ControlCeo Apr 1, 2020
Adp of the SNF May 1, 2020
Sandra Neiman Individual Operational/Managerial Control Nov 25, 2024
Adp of the SNF Nov 25, 2024
William Brent Fowler Individual Operational/Managerial Control Nov 25, 2024
Adp of the SNF Nov 25, 2024
Cody Hartl Individual Operational/Managerial Control Jan 1, 2025
Adp of the SNF Jan 1, 2025
Julie Sanderson-Zaato Individual Operational/Managerial Control Sep 1, 2022
Robert N Hibbard Individual Operational/Managerial Control Nov 25, 2024
Adp of the SNF Nov 25, 2024
James C Larsen Individual Operational/Managerial Control Nov 1, 2024
Adp of the SNF Nov 25, 2024
Sharon Coleman Individual Operational/Managerial Control Nov 25, 2024
Adp of the SNF Nov 25, 2024

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Crook County Medical Services DistrictSundance, WY, CCN 531311 Hospital Operational/Managerial Control May 14, 1999
Crook County Medical Services DistrictSundance, WY, CCN 53Z311 Hospital Operational/Managerial Control Nov 23, 2015
Sundance ClinicSundance, WY, CCN 533976 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 26, 1995

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600905600000",
    "number": "1114086402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 517",
            "address_2": "713 OAK STREET",
            "city": "SUNDANCE",
            "state": "WY",
            "postal_code": "827290517",
            "telephone_number": "307-283-3501",
            "fax_number": "307-283-2255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "713 OAK STREET",
            "city": "SUNDANCE",
            "state": "WY",
            "postal_code": "827290517",
            "telephone_number": "307-283-3501",
            "fax_number": "307-283-2255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROOK COUNTY MEDICAL SERVICES DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-06",
        "last_updated": "2020-09-24",
        "certification_date": "2020-09-24",
        "status": "A",
        "authorized_official_last_name": "LYONS",
        "authorized_official_first_name": "MICKI",
        "authorized_official_middle_name": "DAHNE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "307-283-3501",
        "authorized_official_credential": "DNP"
    },
    "taxonomies": [
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "282E00000X",
            "taxonomy_group": "",
            "desc": "Long Term Care Hospital",
            "state": "WY",
            "license": "07-105",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "315D00000X",
            "taxonomy_group": "",
            "desc": "Hospice, Inpatient",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "106168201",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "106168205",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "106168210",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crook County Nursing Facility",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Crook County Nursing Facility",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Sundance, WY

Sources for this page

Verify at the official NPI Registry.