NPIMap

Organization Active NPI

Campbell County Hospital District

Doing business as Campbell County Medical Group - Geriatric Clinic

  • Geriatric Medicine (Internal Medicine) Physician
  • Gillette, WY
National Provider Identifier
1164934121
Registry record updated Apr 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
Legal business name
CAMPBELL COUNTY HOSPITAL DISTRICT
Doing business as
Campbell County Medical Group - Geriatric Clinic
Practice address
501 S Burma Ave
Gillette, WY 82716-3426
Phone
(307) 688-3636
NPI assigned
Oct 31, 2017
Last updated
Apr 3, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2024

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

Authorized official

Name
Douglas Adam Popp
Title
Chief Financial Officer
Phone
(307) 688-1523

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) Physician 207RG0300X NU Primary
Hospice and Palliative Medicine (Family Medicine) Physician 207QH0002X NU

Addresses

Primary practice location

501 S Burma Ave
Gillette, WY 82716-3426

Mailing address

PO Box 3046
Gillette, WY 82717-3046
Phone (307) 688-2600

Other names 1

  • Campbell County Medical Group - Geriatric Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040206000510 WY Part B Supplier - Clinic/Group Practice 2860392529 Receives reassigned benefits from 299 practitioners
27 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Wright, WY; Gillette, WY; Sheridan, WY; Hulett, WY

Other NPIs on the same Medicare enrollment 27

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

View all 27

National Provider Directory

National Provider Directory
Tax ID family
Wyoming Regional Counseling35 organizations share this tax ID, including this one

Other organizations with this tax ID 34

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

View all 34

Practitioners & affiliated clinicians

Practitioners 2

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": "1509408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712102400000",
    "number": "1164934121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3046",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827173046",
            "telephone_number": "307-688-2600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 S BURMA AVE",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827163426",
            "telephone_number": "307-688-3636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMPBELL COUNTY HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-31",
        "last_updated": "2024-04-03",
        "certification_date": "2024-04-03",
        "status": "A",
        "authorized_official_last_name": "POPP",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "ADAM",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "307-688-1523"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207QH0002X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Hospice and Palliative Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Campbell County Medical Group - Geriatric Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gillette, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.