NPIMap

Organization Active NPI

Memorial Hospital of Converse County

  • Medicare Defined Swing Bed Hospital Unit
  • Douglas, WY
National Provider Identifier
1285643221
Registry record updated Feb 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
07163 Issued in WY
Legal business name
MEMORIAL HOSPITAL OF CONVERSE COUNTY
Practice address
111 S 5TH St
Douglas, WY 82633-2434
Phone
(307) 358-2122
Fax
(307) 358-9216
NPI assigned
Aug 7, 2006
Last updated
Feb 20, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
MEMORIAL HOSPITAL OF CONVERSE COUNTYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 20, 2008

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

Authorized official

Name
Mr. Curt Dugger
Title
Cfo
Phone
(307) 358-2122

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 07163 WY Primary

Addresses

Primary practice location

111 S 5TH St
Douglas, WY 82633-2434

Mailing address

111 S 5TH St
P.O. Box 1450
Douglas, WY 82633-2434
Phone (307) 358-2122

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070827000333 WY Part A Provider - Critical Access Hospital 2264340843 Practice locations: Douglas, WY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285643221. Details of each certification follow.

Hospital certification: CCN 53Z302

Legal name
MEMORIAL HOSPITAL OF CONVERSE COUNTY
Organization structure
GovernmentNon-profit
Enrollment address
111 S 5TH St
Douglas, WY 82633-2434
Hospital Swing-Bed Unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Memorial Hospital County5 organizations share this tax ID, including this one
Part of
Memorial Hospital County

Other organizations with this tax ID 4

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

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Memorial Hospital of Converse County Organization, Douglas, WY 5% Or Greater Indirect Ownership Interest Jan 1, 2014 100%
James Cussins Individual W-2 Managing EmployeeCfo Jan 1, 2019 100%
Matthew M Dammeyer Individual Corporate DirectorCeo Nov 1, 2019 100%

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Memorial Hospital of Converse CountyDouglas, WY, CCN 531302 Hospital 5% Or Greater Direct Ownership Interest (100%) Dec 31, 2009
Register Cliff Rural Health ClinicGuernsey, WY, CCN 533989 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2004
Oregon Trail Rural Health ClinicRolling Hills, WY, CCN 533987 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1990

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Affiliated clinicians 1

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": "1154908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203465600000",
    "number": "1285643221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 S 5TH ST",
            "address_2": "P.O. BOX 1450",
            "city": "DOUGLAS",
            "state": "WY",
            "postal_code": "826332434",
            "telephone_number": "307-358-2122",
            "fax_number": "307-358-9216"
        },
        {
            "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": {
        "organization_name": "MEMORIAL HOSPITAL OF CONVERSE COUNTY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEMORIAL HOSPITAL OF CONVERSE COUNTY",
        "enumeration_date": "2006-08-07",
        "last_updated": "2008-02-20",
        "status": "A",
        "authorized_official_last_name": "DUGGER",
        "authorized_official_first_name": "CURT",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "307-358-2122",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "WY",
            "license": "07163",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Douglas, WY

Sources for this page

Verify at the official NPI Registry.