NPIMap

Organization Active NPI

Summit Pathology

  • Anatomic Pathology & Clinical Pathology Physician
  • Cheyenne, WY
National Provider Identifier
1164020715
Registry record updated Oct 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
Legal business name
SUMMIT PATHOLOGY
Practice address
2301 House Ave Ste 108
Cheyenne, WY 82001-3177
Phone
(307) 274-3057
NPI assigned
Oct 15, 2020
Last updated
Oct 15, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2020

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

Authorized official

Name
Jeff Christinson
Title
Ceo
Phone
(970) 212-0557

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Blood Banking & Transfusion Medicine Physician 207ZB0001X
Hematology (Pathology) Physician 207ZH0000X
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X Primary

Addresses

Primary practice location

2301 House Ave Ste 108
Cheyenne, WY 82001-3177

Mailing address

PO Box 913258
Denver, CO 80291-3258
Phone (970) 212-0530

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150730012393 WY Part B Supplier - Clinic/Group Practice 3971595968 Receives reassigned benefits from 22 practitioners
3 other NPIs on this enrollment
Practice locations: Casper, WY; Cheyenne, WY; Laramie, WY

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 3

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
53D2141206Summit Pathology - Cheyenne2301 House Avenue, Suite 108, Cheyenne, WY 82001AccreditationNov 5, 2027

National Provider Directory

National Provider Directory
Tax ID family
Summit Pathology11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Practitioners & affiliated clinicians

Practitioners 22

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 22

NPI Registry JSON

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

{
    "created_epoch": "1602720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602720000000",
    "number": "1164020715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 913258",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802913258",
            "telephone_number": "970-212-0530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 HOUSE AVE STE 108",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820013177",
            "telephone_number": "307-274-3057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMIT PATHOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-15",
        "last_updated": "2020-10-15",
        "certification_date": "2020-10-15",
        "status": "A",
        "authorized_official_last_name": "CHRISTINSON",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "970-212-0557"
    },
    "taxonomies": [
        {
            "code": "207ZB0001X",
            "taxonomy_group": "",
            "desc": "Pathology, Blood Banking & Transfusion Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ZH0000X",
            "taxonomy_group": "",
            "desc": "Pathology, Hematology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "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 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.