Individual provider Active NPI

Patrick Aaron Robertson, M.D.

  • Orthopaedic Surgery Physician
  • Douglas, WY
National Provider Identifier
1194715037
Registry record updated Nov 5, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
6940A Issued in WY
Practice address
111 S 5TH St
Douglas, WY 82633-2434
Phone
(307) 358-2122
Fax
(307) 358-9216
NPI assigned
Oct 23, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2013

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 6940A WY Primary
Orthopaedic Surgery Physician 207X00000X 153414 MA
Orthopaedic Surgery Physician 207X00000X 10168 NH
Orthopaedic Surgery Physician 207X00000X 95-00203 NC
Orthopaedic Surgery Physician 207X00000X MD14964 ME

Addresses

Primary practice location

111 S 5TH St
Douglas, WY 82633-2434

Mailing address

PO Box 1450
Douglas, WY 82633-1450
Phone (307) 358-1403

Other identifiers 3

IdentifierTypeStateIssuer
1194715037MedicaidME
6940AOtherWYMEDICAL LICENSE
119905600MedicaidWY

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041006000474 WY Practitioner - Orthopedic SurgeryPractitioner - Emergency Medicine 5193623072 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
153414MAMDOrthopaedic Surgery Physician
95-00203NCMDOrthopaedic Surgery Physician
10168NHMDOrthopaedic Surgery Physician
6940AWYMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Hospital of Converse County Current Accepting new patients
Memorial Hospital of Converse County CurrentSince Nov 1, 2013 Accepting new patients
Associates in York Orthopaedics Orthopaedic Surgery Past Accepting new patients

Locations

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 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1130025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383609600000",
    "number": "1194715037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1450",
            "city": "DOUGLAS",
            "state": "WY",
            "postal_code": "826331450",
            "telephone_number": "307-358-1403",
            "fax_number": "307-358-3432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 S 5TH ST",
            "city": "DOUGLAS",
            "state": "WY",
            "postal_code": "826332434",
            "telephone_number": "307-358-2122",
            "fax_number": "307-358-9216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "PATRICK",
        "middle_name": "AARON",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-23",
        "last_updated": "2013-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "WY",
            "license": "6940A",
            "primary": true
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "MA",
            "license": "153414",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NH",
            "license": "10168",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NC",
            "license": "95-00203",
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "ME",
            "license": "MD14964",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1194715037",
            "state": "ME"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "6940A",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119905600",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Douglas, WY

Sources for this page

Verify at the official NPI Registry.