Active NPI
Mudassir Shah Akhter, MD
- Pediatrics Physician
- Cheyenne, WY
National Provider Identifier
1114403151
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 16979A
- Practice address
- 214 E 23Rd St
Cheyenne, WY 82001-3748 - Phone
- (307) 634-2273
- NPI assigned
- Jul 12, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | 20180119719 | MO | |
| Pediatrics Physician | 208000000X | 16979A | WY | Primary |
Addresses
Primary practice location
214 E 23Rd St
Cheyenne, WY 82001-3748
Mailing address
PO Box 20970
Cheyenne, WY 82003-7020
Phone (307) 634-2273
Other practice location 1
1402 S Grand Blvd # M260
Saint Louis, MO 63104-1004
Phone (977) 314-5666
Other practice location 2
2201 Hempstead Tpke
East Meadow, NY 11554-1859
Phone (516) 572-6637
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | makhter63169@direct.crmcwy.org | Direct | Memorial Hospital of Laramie County |
| Direct Messaging Address | makhter63169@direct.crmcwy.org | Health Information Exchange (HIE) | Memorial Hospital of Laramie County |
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 16979A | WY | MD | Pediatrics Physician |
| 20180119719 | MO | MD | Student in an Organized Health Care Education/Training Program |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Memorial Hospital of Laramie County | Current | Accepting new patients |
Locations
214 E 23rd St
Cheyenne, WY 82001
Phone (307) 324-2221
Interoperability endpoints
- makhter63169@direct.crmcwy.org
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.
-
- General Acute Care Hospital
- Cheyenne, WY
- NPI 1285621839
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1531353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1729036800000",
"number": "1114403151",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 20970",
"city": "CHEYENNE",
"state": "WY",
"postal_code": "820037020",
"telephone_number": "307-634-2273"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "214 E 23RD ST",
"city": "CHEYENNE",
"state": "WY",
"postal_code": "820013748",
"telephone_number": "307-634-2273"
}
],
"practiceLocations": [
{
"address_1": "1402 S Grand Blvd # M260",
"address_purpose": "LOCATION",
"city": "Saint Louis",
"state": "MO",
"postal_code": "631041004",
"country_code": "US",
"telephone_number": "977-314-5666",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2201 Hempstead Tpke",
"address_purpose": "LOCATION",
"city": "East Meadow",
"state": "NY",
"postal_code": "115541859",
"country_code": "US",
"telephone_number": "516-572-6637",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "AKHTER",
"first_name": "MUDASSIR",
"middle_name": "SHAH",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-07-12",
"last_updated": "2024-10-16",
"certification_date": "2024-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "MO",
"license": "20180119719",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "WY",
"license": "16979A",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "makhter63169@direct.crmcwy.org",
"affiliation": "Y",
"endpointDescription": "CRMC Direct Address",
"affiliationName": "Memorial Hospital of Laramie County",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "214 E 23rd St",
"city": "Cheyenne",
"state": "WY",
"country_code": "US",
"postal_code": "820013748",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "makhter63169@direct.crmcwy.org",
"affiliation": "Y",
"endpointDescription": "CRMC Direct Address",
"affiliationName": "Memorial Hospital of Laramie County",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "214 E 23rd St",
"city": "Cheyenne",
"state": "WY",
"country_code": "US",
"postal_code": "820013748",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Cheyenne, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2024; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.