Sterling Provider Group
Organization Active NPI Rural Health Clinic/Center · Evanston, WY
NPI 1164044962 · NPPES record last updated Jun 17, 2026
Key facts
- NPI
- 1164044962
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 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
- Organization subpart
- No
Authorized official
- Name
- Corbin Bunnage, PA-C
- Title
- Provider/Owner
- Phone
- (208) 542-9111
Owners & managing parties with NPI records 5
-
Corbin Bunnage, PA-C
-
Devon E. Dahlke, PA-C
-
Adam Garfield, P.A.
-
Matthew F Harris, MD
Other NPIs with the same Medicare PAC ID 7
Corporate family (same tax ID) 18
Practitioners 52
-
Tamara Sue Bach, FNP-BC
-
Kaylun Grandy, PA-C
-
Susan M. Miner, APRN, FNP-C
-
Michael Anthony Paglia, P.A.
-
Angela M Abel, NP
-
Robert Baird, NP
-
Ashley Baker, PA
-
Michael J Barbo, PA
-
Corey Bingham, FNP-BC
-
Taylor Bird, PA-C
-
Joshua Phillip Black, PA-C
-
Corbin Bunnage, PA-C
-
Peter Joel Christiansen, PA-C
-
Bretta Lee Cyr, PA
-
Devon E. Dahlke, PA-C
-
Laura Drake, PA-C
-
Brandon D Durfee, PA-C
-
Nicole M Dwyer, PA
-
Jordan Gregory Evans, PA-S
-
Chuck B Fuller, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WY
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
- LLC · Proprietary
- Incorporated
- Feb 3, 2020 in WY
- Enrollment address
- 1952 Harrison Dr
Ste 1
Evanston, WY 82930-3241
All disclosed owners & managing parties 5
| Name | Role | Since | Share |
|---|---|---|---|
| Matthew F Harris |
5% Or Greater Direct Ownership Interest |
Jan 4, 2019 | 9% |
| Adam T Garfield |
5% Or Greater Direct Ownership Interest |
Jan 4, 2019 | 5% |
| Operational/Managerial Control |
Jan 1, 2023 | 100% | |
| Corbin Bunnage |
5% Or Greater Direct Ownership Interest |
Jan 4, 2019 | 21% |
| Devon E Dahlke |
5% Or Greater Direct Ownership Interest |
Jan 4, 2019 | 21% |
| Jacob D Anderson |
5% Or Greater Direct Ownership Interest |
Jan 4, 2019 | 5% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240830003632 | WY | Part a Provider - Rural Health Clinic | 2264773373 | Practice locations: Evanston, WY |
National Provider Directory
- Tax ID family
- Sterling Provider Group
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | |||
| Primary Care Clinic/Center | 261QP2300X | |||
| Rural Health Clinic/Center | 261QR1300X | Yes | ||
| 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
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 53D2184485 | Other | WY | CLIA |
Other providers in Evanston, WY
- Southwest Wyoming ENT Inc
- Jay Staley
- Tracy Staniforth
- State of Wyoming
- Maria Stephen
- Dawn Lynn Stewart
- Ann Stoddard
- Brady Scott Stokes
- Martin Fred Stover IV
- Sue J Studt
All providers in Evanston, WY · Rural Health Clinic/Center in Wyoming
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 17, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.