NPIMap

Organization Active NPI

Sterling Provider Group

  • Rural Health Clinic/Center
  • Evanston, WY
National Provider Identifier
1164044962
Registry record updated Jun 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
STERLING PROVIDER GROUP
Practice address
1952 Harrison Dr Ste 1
Evanston, WY 82930-3241
Phone
(208) 542-9111
Fax
(208) 542-9114
NPI assigned
May 14, 2020
Last updated
Jun 17, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2026

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

Authorized official

Name
Corbin Bunnage, PA-CNPI 1447325485
Title
Provider/Owner
Phone
(208) 542-9111

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Primary Care Clinic/Center 261QP2300X
Rural Health Clinic/Center 261QR1300X Primary
Urgent Care Clinic/Center 261QU0200X
Occupational Medicine Clinic/Center 261QX0100X

Addresses

Primary practice location

1952 Harrison Dr Ste 1
Evanston, WY 82930-3241

Mailing address

740 S Woodruff Ave
Idaho Falls, ID 83401-5285
Phone (208) 542-9111

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240830003632 WY Part A Provider - Rural Health Clinic 2264773373 Practice locations: Evanston, WY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1164044962. Details of each certification follow.

Rural health clinic certification: CCN 538901

Legal name
STERLING PROVIDER GROUP
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 21, 2025
Last certification
Feb 21, 2025
Ownership / control type
1C
Organization structure
LLCProprietary
Incorporated
Feb 3, 2020 in WY
Enrollment address
1952 Harrison Dr
Ste 1
Evanston, WY 82930-3241

Other NPIs with the same Medicare PAC ID 7

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

National Provider Directory

National Provider Directory
Tax ID family
Sterling Provider Group19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

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

View all 18

Ownership & related parties

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Matthew F Harris Individual 5% Or Greater Direct Ownership InterestOwner/Provider Jan 4, 2019 9%
Adam T Garfield Individual 5% Or Greater Direct Ownership InterestOwner/Provider Jan 4, 2019 5%
Operational/Managerial ControlChief of Staff Jan 1, 2023 100%
Corbin Bunnage Individual 5% Or Greater Direct Ownership InterestOwner/Provider Jan 4, 2019 21%
Devon E Dahlke Individual 5% Or Greater Direct Ownership InterestOwner/Provider Jan 4, 2019 21%
Jacob D Anderson Individual 5% Or Greater Direct Ownership InterestOwner/Provider Jan 4, 2019 5%

Owners & managing parties with NPI records 5

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1589414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1781654400000",
    "number": "1164044962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "740 S WOODRUFF AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834015285",
            "telephone_number": "208-542-9111",
            "fax_number": "208-542-9114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1952 HARRISON DR STE 1",
            "city": "EVANSTON",
            "state": "WY",
            "postal_code": "829303241",
            "telephone_number": "208-542-9111",
            "fax_number": "208-542-9114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STERLING PROVIDER GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-14",
        "last_updated": "2026-06-17",
        "certification_date": "2026-06-17",
        "status": "A",
        "authorized_official_last_name": "BUNNAGE",
        "authorized_official_first_name": "CORBIN",
        "authorized_official_title_or_position": "PROVIDER/OWNER",
        "authorized_official_telephone_number": "208-542-9111",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evanston, WY

Sources for this page

Verify at the official NPI Registry.