Northeast Wyoming Pediatric Associates, P.C.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

NORTHEAST WYOMING PEDIATRIC ASSOCIATES, P.C.

Practice address

916 Jackson Ave
Sheridan, WY 82801-2708

Phone

(307) 675-5555

Fax

(307) 675-5599

NPI assigned

Jan 27, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Suzanne Oss, M.D.NPI 1316973613

Title

President

Phone

(307) 675-5555

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in WY

Enrollment records 1

Locations

Practitioners 4

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

• Suzanne E K Oss, MD

  • Pediatrics Physician
  • Sheridan, WY
  • NPI 1316973613

  WY

  Medicare reassignment Authorized official
• Marcella Wildeman, DNP, FNP-BC

  • Primary Care Nurse Practitioner
  • Sheridan, WY
  • NPI 1285185231

  WY

  Medicare reassignment NPD
• Marilyn Kay Horsley, P.A.-C

  • Physician Assistant
  • Sheridan, WY
  • NPI 1992782619

  WY

  Medicare reassignment
• Michael Quintin Sanderson, M.D.

  • Pediatrics Physician
  • Sheridan, WY
  • NPI 1053769943

  Pediatrics

  NPD

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

{
    "created_epoch": "1138320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725926400000",
    "number": "1114998259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "916 JACKSON AVE",
            "city": "SHERIDAN",
            "state": "WY",
            "postal_code": "828012708",
            "telephone_number": "307-675-5555",
            "fax_number": "307-675-5599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "916 JACKSON AVE",
            "city": "SHERIDAN",
            "state": "WY",
            "postal_code": "828012708",
            "telephone_number": "307-675-5555",
            "fax_number": "307-675-5599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST WYOMING PEDIATRIC ASSOCIATES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-27",
        "last_updated": "2024-09-10",
        "certification_date": "2024-08-29",
        "status": "A",
        "authorized_official_last_name": "OSS",
        "authorized_official_first_name": "SUZANNE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "307-675-5555",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000405665",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100048900",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BS WY",
            "identifier": "00941001",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7705130",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Timothy D. Nostrum, M.D.
• Janet Nowak, R.D.
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• All providers in Sheridan, WY
• Pediatrics Physician in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2024; 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.