NPIMap

Organization Active NPI

Wyoming Medical Associates, LLC

  • Clinic/Center
  • Gillette, WY
National Provider Identifier
1114531118
Registry record updated Jan 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
WYOMING MEDICAL ASSOCIATES, LLC
Practice address
51 Town Center Dr Ste 120
Gillette, WY 82718-5521
Phone
(307) 682-9962
Fax
(307) 257-2930
NPI assigned
Sep 7, 2020
Last updated
Jan 20, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2026

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

Authorized official

Name
Dennis Dale Jack
Title
Ceo
Phone
(307) 682-9962

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

51 Town Center Dr Ste 120
Gillette, WY 82718-5521

Mailing address

PO Box 1805
Gillette, WY 82717-1805
Phone (307) 682-9962

Other practice location 1

6500 E 2nd St Ste 101
Casper, WY 82609-4339
Phone (307) 682-9962 ext. 29962

Other practice location 2

79 Town Center Dr Ste 110
Gillette, WY 82718-5534
Phone (307) 682-9962

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201029002875 WY Part B Supplier - Clinic/Group Practice 2769802552 Receives reassigned benefits from 19 practitioners
1 other NPI on this enrollment
Practice locations: Casper, WY; Gillette, WY

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

79 Town Center Dr
Ste 110
Gillette, WY 82718
Phone (307) 682-9962

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1599436800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1768867200000",
    "number": "1114531118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1805",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827171805",
            "telephone_number": "307-682-9962",
            "fax_number": "307-257-2930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51 TOWN CENTER DR STE 120",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827185521",
            "telephone_number": "307-682-9962",
            "fax_number": "307-257-2930"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6500 E 2nd St Ste 101",
            "address_purpose": "LOCATION",
            "city": "Casper",
            "state": "WY",
            "postal_code": "826094339",
            "country_code": "US",
            "telephone_number": "307-682-9962 x29962",
            "fax_number": "307-257-2930",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "79 Town Center Dr Ste 110",
            "address_purpose": "LOCATION",
            "city": "Gillette",
            "state": "WY",
            "postal_code": "827185534",
            "country_code": "US",
            "telephone_number": "307-682-9962",
            "fax_number": "307-257-2930",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WYOMING MEDICAL ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-07",
        "last_updated": "2026-01-20",
        "certification_date": "2026-01-20",
        "status": "A",
        "authorized_official_last_name": "JACK",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "DALE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "307-682-9962"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "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 Jan 20, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.