Central Wyoming Hospice Program
Organization Active NPI Community Based Hospice Care Agency · Casper, WY
NPI 1295725976 · NPPES record last updated Jan 28, 2020
Key facts
- NPI
- 1295725976
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- License
- 06 160 (WY)
- Legal business name
- CENTRAL WYOMING HOSPICE PROGRAM
- Practice address
- 319 S Wilson St
Casper, WY 82601-2943 - Phone
- (307) 577-4832
- Fax
- (307) 577-4841
- NPI assigned
- Oct 25, 2005
- Organization subpart
- No
Authorized official
- Name
- Kilty Brown
- Title
- Executive Director
- Phone
- (307) 577-4832
Owners & managing parties with NPI records 1
-
Joseph K Schoeber, M.D.
Member organizations 2
Practitioners 2
-
Tracy Dawn Perkins, FNP-BC
Affiliated clinicians 15
-
Alexandra Brodka, MD
-
Mary Frances Burke, M.D.
-
Sharon R Karnes, M.D.
-
Karli McMillan, D.O.
-
Joseph K Schoeber, M.D.
-
Tina M Stanco, MD
-
Tabitha Lucynda Thrasher, D,O.
-
Marjorie Lynn Wells, M.D.
Medicare Care Compare: Hospice
- Listed as
- Central Wyoming Hospice Program
- Ownership
- Non-Profit
- Certified
- Jan 6, 1992
- Medicare certification status
- Active
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 53D2230824 | Central Wyoming Hospice Program | Certificate of waiver | Jul 27, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WY
Hospice certification: CCN 531501
- Legal name
- CENTRAL WYOMING HOSPICE PROGRAM
- Doing business as
- CENTRAL WYOMING HOSPICE & TRANSITIONS
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Jan 6, 1992
- Last certification
- Feb 13, 2020
- Ownership / control type
- Non-Profit - Private
- Organization structure
- Corporation · Non-profit
- Incorporated
- Sep 20, 1980 in WY
- Enrollment address
- 319S Wilson St
Casper, WY 82601-2943
All disclosed owners & managing parties 6
| Name | Role | Since | Share |
|---|---|---|---|
| Lisa Mathiowetz |
W-2 Managing Employee |
Jul 1, 2015 | |
| Larry a Kloster |
Corporate Officer |
Jan 1, 2022 | |
| Joan Means |
Other | Jan 1, 2022 | |
| Joseph K Schoeber |
Contracted Managing Employee |
Jun 1, 2003 | |
| Stuart Atnip |
Other | Jan 1, 2018 | |
| Kilty Brown |
W-2 Managing Employee |
Jun 18, 2017 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20030804000024 | WY | Part a Provider - Hospice | 8123939832 | Practice locations: Casper, WY |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | 06 160 | WY | Yes |
Addresses
Primary practice location
319 S Wilson St
Casper, WY 82601-2943
Mailing address
319 S Wilson St
Casper, WY 82601-2943
Phone (307) 577-4832
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 106565301 | Medicaid | WY |
Other providers in Casper, WY
- Maureen Lucille Cellmer
- Centrad Healthcare LLC
- Central Wyoming Counseling Center
- Central Wyoming Counseling Center
- Central Wyoming Eye Clinic, PC
- Central Wyoming Neurology, LLC
- Central Wyoming Neurosurgery LLC
- Central Wyoming Optometric Center PC
- Central Wyoming Outpatient Surgery Center, LLC
- Central Wyoming Oxygen, LLC
All providers in Casper, WY · Community Based Hospice Care Agency in Wyoming
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 28, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.