Active NPI
West Park Hospital Home Health
Doing business as Spirit Mountain Hospice
- Community Based Hospice Care Agency
- Cody, WY
National Provider Identifier
1194805648
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Based Hospice Care Agency
- License
- 06-003
- Legal business name
- WEST PARK HOSPITAL HOME HEALTH
- Doing business as
- Spirit Mountain Hospice
- Practice address
- 707 Sheridan Ave
Cody, WY 82414-3409 - Phone
- (307) 527-7501
- Fax
- (307) 578-2485
- NPI assigned
- Oct 17, 2006
- Last updated
- Sep 25, 2012
- Organization subpart
- Yes
- Parent organization
- WEST PARK HOSPITAL DISTRICT
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Patrick McConnell
- Title
- Cfo
- Phone
- (307) 578-2490
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | 06-003 | WY | Primary |
Addresses
Primary practice location
707 Sheridan Ave
Cody, WY 82414-3409
Mailing address
707 Sheridan Ave
Cody, WY 82414-3409
Phone (307) 527-7501
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 041608 | Other | WY | BLUE CROSS |
| 106133007 | Medicaid | WY | |
| 007062 | Other | WY | BLUE CROSS |
Other names 1
- Spirit Mountain Hospice
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120925000426 | WY | Part A Provider - Hospice | 8729234133 | Practice locations: Cody, WY |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1194805648. Details of each certification follow.
Hospice certification: CCN 531505
- Legal name
- WEST PARK HOSPITAL HOME HEALTH
- Doing business as
- CODY REGIONAL HEALTH HOME HEALTH AND SPIRIT MOUNTAIN HOSPICE
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Aug 4, 1994
- Last certification
- Jun 20, 2019
- Ownership / control type
- Combination Government and Nonprofit
- Organization structure
- Government
- Enrollment address
- 808 Canyon View Ave
Cody, WY 82414-3032
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
Care Compare: Hospice
Medicare Care Compare- Listed as
- Cody Regional Health Spirit Mountain Hospice
- Ownership
- Government
- Certified
- Aug 4, 1994
- Medicare certification status
- Active
National Provider Directory
National Provider Directory- Tax ID family
- Home Health
- Part of
- Lake Hospital
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Home Health Agency
- Cody, WY
- NPI 1780772293
Ownership & related parties
All disclosed owners & managing parties 5
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Elizabeth Poeverlein | Operational/Managerial Control | Nov 26, 2024 | 100% |
| Angela Johnson | Other | Jan 1, 2024 | |
| Richard Tyler Nelson | Other | Jan 1, 2022 | |
| West Park Hospital District | Other | Jul 1, 1995 | 100% |
| Mary Hannah McRae | Corporate Officer | Oct 1, 2020 |
Owners & managing parties with NPI records 6
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Durable Medical Equipment & Medical Supplies
- Cody, WY
- NPI 1467442459
Other
-
dba Cody Regional Health
- Critical Access Hospital
- Cody, WY
- NPI 1558351536
Other
-
- Skilled Nursing Facility
- Cody, WY
- NPI 1467534081
Other
Practitioners & affiliated clinicians
Affiliated clinicians 7
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161043200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1348531200000",
"number": "1194805648",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "707 SHERIDAN AVE",
"city": "CODY",
"state": "WY",
"postal_code": "824143409",
"telephone_number": "307-527-7501",
"fax_number": "307-578-2485"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "707 SHERIDAN AVE",
"city": "CODY",
"state": "WY",
"postal_code": "824143409",
"telephone_number": "307-527-7501",
"fax_number": "307-578-2485"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WEST PARK HOSPITAL HOME HEALTH",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "WEST PARK HOSPITAL DISTRICT",
"enumeration_date": "2006-10-17",
"last_updated": "2012-09-25",
"status": "A",
"authorized_official_last_name": "MCCONNELL",
"authorized_official_first_name": "PATRICK",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "307-578-2490",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "251G00000X",
"taxonomy_group": "",
"desc": "Hospice Care, Community Based",
"state": "WY",
"license": "06-003",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "041608",
"state": "WY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "106133007",
"state": "WY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "007062",
"state": "WY"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Spirit Mountain Hospice",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Cody, WY
- West Park Hospital District
- West Park Hospital District (COE Pharmacy)
- West Park Hospital District
- West Park Hospital District Hospitalists
- West Park Hospital District Long Term Care Center
- West Park Hospital Home Health
- Sandra E Whalen, C.R.N.A.
- Robert Scott White, D.O.
- Alyssa Jo Whitlock
- Sarah Elizabeth Whitlock, FNP-C
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- 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.