Individual provider Active NPI

Gordon Todd Erickson, PA

  • Physician Assistant
  • Casper, WY
National Provider Identifier
1194033530
Registry record updated Mar 31, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
501 Issued in WY
Practice address
5820 E 2ND St
Casper, WY 82609-4308
Phone
(307) 234-9037
Fax
(307) 234-9042
NPI assigned
Sep 20, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 501 WY Primary

Addresses

Primary practice location

5820 E 2ND St
Casper, WY 82609-4308

Mailing address

5820 E 2ND St
Casper, WY 82609-4308
Phone (307) 234-9037

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160503000230 WY Practitioner - Physician Assistant 7416256045 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Summit Memorial Medical Group LLCGroup PAC ID 1254876683, 40 clinicians

Practice addresses (Care Compare)

222 S 5TH St
Douglas, WY 82633-2534
Phone (307) 286-6738

5820 E 2ND St
Casper, WY 82609-4308
Phone (307) 234-9042

700 E Ctr St
Douglas, WY 82633-2446
Phone (307) 358-7300

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
33.71 of 100Reported as group
Quality
39.66
Improvement activities
0

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
501WYMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Hospital of Converse County CurrentSince May 1, 2019 Accepting new patients

Locations

5820 E 2nd St
Casper, WY 82609
Phone (307) 234-9037

111 S 5th St
Douglas, WY 82633
Phone (307) 358-6200

2901 Powder Basin Ave
Gillette, WY 82718
Phone (307) 358-6200

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 5

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

NPI Registry JSON

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

{
    "created_epoch": "1284940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459382400000",
    "number": "1194033530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5820 E 2ND ST",
            "city": "CASPER",
            "state": "WY",
            "postal_code": "826094308",
            "telephone_number": "307-234-9037",
            "fax_number": "307-234-9042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5820 E 2ND ST",
            "city": "CASPER",
            "state": "WY",
            "postal_code": "826094308",
            "telephone_number": "307-234-9037",
            "fax_number": "307-234-9042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ERICKSON",
        "first_name": "GORDON",
        "middle_name": "TODD",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-09-20",
        "last_updated": "2016-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WY",
            "license": "501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Casper, WY

Sources for this page

Verify at the official NPI Registry.