Individual provider Active NPI

Thomas H Etter, D.O.

  • Surgery Physician
  • Cody, WY
National Provider Identifier
1154562791
Registry record updated Apr 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
9334A Issued in WY
Practice address
424 Yellowstone Ave Ste 250
Cody, WY 82414-9310
Phone
(307) 578-2922
Fax
(307) 578-2192
NPI assigned
Mar 11, 2009
Last updated
Apr 17, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X TL2094 WY
Surgery Physician 208600000X 2006003130 MO
Surgery Physician 208600000X 9334A WY Primary

Addresses

Primary practice location

424 Yellowstone Ave Ste 250
Cody, WY 82414-9310

Mailing address

424 Yellowstone Ave Ste 250
Cody, WY 82414-9310
Phone (307) 578-2922

Other identifiers 9

IdentifierTypeStateIssuer
12740475OtherMOMULTIPLAN
12740475OtherMOPHCS
9847314OtherMOAETNA
28058OtherMOGHP
3032610OtherMOUNITED HEALTHCARE
622086OtherMOANTHEM BLUECROSS BLUESHIELD
921792OtherMOHEALTHLINK INC
1154562791MedicaidMO
135178800MedicaidWY

Other names 1

  • Thomas Etter Other name

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130611000472 WY Practitioner - General SurgeryPractitioner - GastroenterologyPractitioner - Colorectal Surgery (Proctology) 7517010895 Reassigns benefits to 3 organizations
Practice locations: Cody, WY

Care Compare profile

Medicare Care Compare
Specialty
General SurgeryAlso: Colorectal Surgery (Proctology), Gastroenterology
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
West Park Hospital DistrictGroup PAC ID 7315855624, 85 clinicians

Practice addresses (Care Compare)

424 Yellowstone Ave
Suite 250
Cody, WY 82414-9310
Phone (307) 296-1355

707 Sheridan Ave
Cody, WY 82414-3409
Phone (307) 527-7501

902 Blackburn St
Cody, WY 82414-8494
Phone (307) 296-1355

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
85.58 of 100Reported as group
Quality
81.44
Promoting interoperability
92
Improvement activities
40
Cost
77.18

Merit-based Incentive Payment System (MIPS)

Final score
80.79 of 100Reported as group
Quality
72.82
Promoting interoperability
100
Improvement activities
40
Cost
63.14

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion1-10
Colonoscopy81
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)19
Mastectomy18
Upper gastrointestinal (GI) endoscopy for acid reflux95
Melanoma (skin cancer) excision11

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
TL2094WYMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Thomas Etter, LLC Surgery CurrentSince Jan 28, 2022 Accepting new patients
Cody Regional Health EMS CurrentSince Jan 1, 2026 Accepting new patients
Brandi R Shepard LLC CurrentSince Aug 14, 2022 Accepting new patients
Columbia Surgical Associates Inc Surgery Past Accepting new patients
West Park Hospital District Past Accepting new patients

Locations

424 Yellowstone Ave
Ste 120
Cody, WY 82414
Phone (307) 578-2903

424 Yellowstone Ave
Ste 250
Cody, WY 82414
Phone (307) 296-1355

707 Sheridan Ave
Cody, WY 82414
Phone (307) 527-7561

720 Lindsay Ln
Ste C
Cody, WY 82414
Phone (307) 578-1955

902 Blackburn St
Cody, WY 82414
Phone (307) 296-1355

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1236729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776384000000",
    "number": "1154562791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "424 YELLOWSTONE AVE STE 250",
            "city": "CODY",
            "state": "WY",
            "postal_code": "824149310",
            "telephone_number": "307-578-2922",
            "fax_number": "307-578-2192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "424 YELLOWSTONE AVE STE 250",
            "city": "CODY",
            "state": "WY",
            "postal_code": "824149310",
            "telephone_number": "307-578-2922",
            "fax_number": "307-578-2192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETTER",
        "first_name": "THOMAS",
        "middle_name": "H",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-03-11",
        "last_updated": "2026-04-17",
        "certification_date": "2026-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WY",
            "license": "TL2094",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MO",
            "license": "2006003130",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WY",
            "license": "9334A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MULTIPLAN",
            "identifier": "12740475",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHCS",
            "identifier": "12740475",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "9847314",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHP",
            "identifier": "28058",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "3032610",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUECROSS BLUESHIELD",
            "identifier": "622086",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK INC",
            "identifier": "921792",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1154562791",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "135178800",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "THOMAS",
            "last_name": "ETTER",
            "credential": "D.O.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Cody, WY

Sources for this page

Verify at the official NPI Registry.