Jeffery W Edstrom

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

129337 Issued in WI

Practice address

497 W Lott St
Buffalo, WY 82834-1658

Phone

(307) 684-5521

Fax

(307) 684-5385

NPI assigned

Jun 15, 2005

Last updated

Jun 3, 2014By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Jeff W Edstrom Other name

Medicare fee-for-service enrollment

Enrolled in WY

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Family Medical CenterGroup PAC ID 1557344371, 22 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Johnson County Healthcare Center Hospital, Buffalo, WY, CCN 531308

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

Locations

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.

• Family Medical Center

  • Clinic/Center
  • Buffalo, WY
  • NPI 1285612317
  Medicare reassignment Care Compare group NPD
• Jeffery W. Edstrom

  • Certified Registered Nurse Anesthetist
  • Sheridan, WY
  • NPI 1871916544

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Johnson County Memorial Hospital

  dba Johnson County Healthcare Center

  • Critical Access Hospital
  • Buffalo, WY
  • NPI 1003894122
  Medicare reassignment NPD
• Johnson County Memorial Hospital

  dba Johnson County Healthcare Center Home Health Agency

  • Home Health Agency
  • Buffalo, WY
  • NPI 1992784961
  NPD
• Hennepin County

  dba Hennepin County Mental Health Center

  • Psychiatry Physician
  • Minneapolis, MN
  • NPI 1780790345
  NPD (past)

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

• Johnson County Memorial Hospital

  dba Johnson County Healthcare Center

  • Critical Access Hospital
  • Buffalo, WY
  • NPI 1003894122
  Care Compare affiliation

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

{
    "created_epoch": "1118793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1401753600000",
    "number": "1164427274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "553 N PINNACLE DR",
            "city": "BUFFALO",
            "state": "WY",
            "postal_code": "828341416",
            "telephone_number": "307-684-7817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "497 W LOTT ST",
            "city": "BUFFALO",
            "state": "WY",
            "postal_code": "828341658",
            "telephone_number": "307-684-5521",
            "fax_number": "307-684-5385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDSTROM",
        "first_name": "JEFFERY",
        "middle_name": "W",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-15",
        "last_updated": "2014-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "WI",
            "license": "129337",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43403300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JEFF",
            "last_name": "EDSTROM",
            "middle_name": "W",
            "credential": "CRNA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Hope Anne Donahue
• Melody Donahue
• Haley Beckwith Drake
• Justyce Shy Duffield, DC
• Eagle Summit Dental Clinic, Inc
• Elder Care Inc
• Cherika Eve Erlenbusch
• Madonna Bell Esponda, L.P.C.
• Eye Attire LLC
• Family Medical Center

• Certified Registered Nurse Anesthetist in Buffalo, WY
• Providers in Buffalo, WY by specialty
• Certified Registered Nurse Anesthetist in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2014; 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.