Individual provider Active NPI

Amy Maxson, PA C

  • Physician Assistant
  • Lander, WY
National Provider Identifier
1245332337
Registry record updated Sep 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
321 Issued in WY
Practice address
535 E Main St Ste a
Lander, WY 82520-3424
Phone
(307) 233-0553
Fax
(307) 337-9029
NPI assigned
Sep 1, 2006
Last updated
Sep 19, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 321 WY Primary
Medical Physician Assistant 363AM0700X 8722 AZ
Medical Physician Assistant 363AM0700X MD1123075 WY

Addresses

Primary practice location

535 E Main St Ste a
Lander, WY 82520-3424

Mailing address

535 E Main St Ste a
Lander, WY 82520-3424
Phone (307) 233-0553

Other identifiers 5

IdentifierTypeStateIssuer
605960009OtherWYFBL
120542100MedicaidWY
Z265974OtherAZMEDICARE
103077MedicaidAZ
314523OtherWYBSWY

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
I20041214001159 WY Practitioner - Physician Assistant 9537158936 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
University of North Dakota School of Medicine, 2004
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

535 E Main St
Lander, WY 82520-3424

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
321WYMDPhysician Assistant
8722AZMDMedical Physician Assistant
MD1123075WYMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Memorial Medical Group LLC CurrentSince Feb 24, 2025 Accepting new patients

Locations

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

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

535 E Main St
Ste A
Lander, WY 82520
Phone (307) 233-0553

535 E Main St
Ste B
Lander, WY 82520
Phone (307) 206-1224

Organizations & group practices 1

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

Hospital & facility affiliations 2

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": "1157068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758240000000",
    "number": "1245332337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "535 E MAIN ST STE A",
            "city": "LANDER",
            "state": "WY",
            "postal_code": "825203424",
            "telephone_number": "307-233-0553",
            "fax_number": "307-337-9029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "535 E MAIN ST STE A",
            "city": "LANDER",
            "state": "WY",
            "postal_code": "825203424",
            "telephone_number": "307-233-0553",
            "fax_number": "307-337-9029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAXSON",
        "first_name": "AMY",
        "name_prefix": "Mrs.",
        "credential": "PA C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-01",
        "last_updated": "2025-09-19",
        "certification_date": "2025-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WY",
            "license": "321",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AZ",
            "license": "8722",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WY",
            "license": "MD1123075",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FBL",
            "identifier": "605960009",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "120542100",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "Z265974",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103077",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BSWY",
            "identifier": "314523",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lander, WY

Sources for this page

Verify at the official NPI Registry.