NPIMap

Organization Active NPI

Riverton Physician Practices, LLC

  • Emergency Medicine Physician
  • Riverton, WY
National Provider Identifier
1205875614
Registry record updated May 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
RIVERTON PHYSICIAN PRACTICES, LLC
Practice address
1005 College View Dr
Riverton, WY 82501-2266
Phone
(307) 857-5280
Fax
(307) 857-5215
NPI assigned
Jun 5, 2006
Last updated
May 28, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 28, 2026

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

Authorized official

Name
Jonetta M Traylor
Title
Administrator
Phone
(502) 596-6063

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X WY Primary

Addresses

Primary practice location

1005 College View Dr
Riverton, WY 82501-2266

Mailing address

1005 College View Dr
Riverton, WY 82501-2289
Phone (307) 857-5280

Other identifiers 1

IdentifierTypeStateIssuer
114098100MedicaidWY

Other names 1

  • Lifepoint Hospitals Holdings, Inc Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040505000232 WY Part B Supplier - Clinic/Group Practice 8426954496 Receives reassigned benefits from 51 practitioners
6 other NPIs on this enrollment
Practice locations: Riverton, WY; Lander, WY

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory
Tax ID family
Riverton Physician Practices LLC7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

545 E Main St
Lander, WY 82520

Practitioners & affiliated clinicians

Practitioners 61

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.

View all 61

NPI Registry JSON

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

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779926400000",
    "number": "1205875614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1005 COLLEGE VIEW DR",
            "city": "RIVERTON",
            "state": "WY",
            "postal_code": "825012289",
            "telephone_number": "307-857-5280",
            "fax_number": "307-857-5215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 COLLEGE VIEW DR",
            "city": "RIVERTON",
            "state": "WY",
            "postal_code": "825012266",
            "telephone_number": "307-857-5280",
            "fax_number": "307-857-5215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERTON PHYSICIAN PRACTICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-05",
        "last_updated": "2026-05-28",
        "certification_date": "2026-05-28",
        "status": "A",
        "authorized_official_last_name": "TRAYLOR",
        "authorized_official_first_name": "JONETTA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "502-596-6063"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "114098100",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lifepoint Hospitals Holdings, Inc",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Riverton, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2026; 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.