Community Health Center of Central Wyoming Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Dubois, WY
NPI 1306136205 · NPPES record last updated Mar 8, 2024
Key facts
- NPI
- 1306136205
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- COMMUNITY HEALTH CENTER OF CENTRAL WYOMING INC
- Practice address
- 5647 US Hwy 26
Dubois, WY 82513-0577 - Phone
- (307) 455-2516
- Fax
- (307) 455-2526
- NPI assigned
- Apr 12, 2011
- Organization subpart
- No
Authorized official
- Name
- Amanda Sisco
- Title
- Revenue Cycle Manager
- Phone
- (307) 233-6000
Owners & managing parties with NPI records 1
-
Sean Frank Ellis, DDS
Owned or controlled facilities with NPI records 1
Other NPIs on the same Medicare enrollment 3
Other NPIs with the same Medicare PAC ID 3
Practitioners 32
-
Kyle Leslie Anderson, FNP-C
-
Jordan Nichole Belser, APRN
-
Sarah Burt, PMHNP
-
Marilyn Long, APRN
-
Ashley Oviedo-Lopez, FNP-BC
-
Leslie Dawn Chitwood, FNP-BC
-
Keith Hageman, LPC
-
Angela Brown, LPC, MS
-
Allysa Nicole Dorsey, FNP
-
Laura M. Hunsaker, LCSW
-
Carol Ann King, MSW, LCSW
-
Sandee K Lewis, NP
-
Sara E Malsom, PA-C
-
Wesley Morris, PA-C
-
Ashley K Mudder, MSW, LCSW
-
Jennifer Ann Pfisterer, DNP, FNP
-
Susanne Elisabeth Ridley, LCSW
-
Melanie Ann Scarbrough, FNP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WY
Federally qualified health center certification: CCN 531814
- Legal name
- COMMUNITY HEALTH CENTER OF CENTRAL WYOMING INC
- Doing business as
- DUBOIS MEDICAL CLINIC
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- Jun 8, 2011
- Last certification
- Jun 8, 2011
- Ownership / control type
- For profit – partnership
- Organization structure
- Corporation · Non-profit
- Incorporated
- Apr 1, 1999 in WY
- Enrollment address
- 5647 US Highway 26
Dubois, WY 82513-9607 - Related CCNs
- 531804
All disclosed owners & managing parties 10
| Name | Role | Since | Share |
|---|---|---|---|
| Kenneth Carpenter |
Corporate Director | Jan 1, 2022 | |
| Carl Harris |
Corporate Officer |
Dec 29, 2019 | |
| Evan Condelario |
Corporate Director | Jan 1, 2021 | |
| Sean F Ellis |
Corporate Director | Jan 1, 2016 | |
| John Angst |
Corporate Director | Jan 1, 2019 | |
| Josephine Gilpatrick |
Corporate Director | Jan 1, 2019 | |
| Danielle Krucheck |
Corporate Director | Jan 1, 2021 | |
| Amanda Sisco |
W-2 Managing Employee |
Feb 8, 2021 | |
| Patti Robinson |
W-2 Managing Employee |
Jul 12, 2021 | |
| Kevin Lanham |
Corporate Officer |
Jan 1, 2020 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Community Health Center of Central Wyoming Inc |
Federally qualified health center | Operational/Managerial Control | Apr 1, 2019 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031105000279 | WY | Part B Supplier - Clinic/Group Practice | 3375454705 |
Receives reassigned benefits from 41 practitioners 5 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Lander, WY; Riverton, WY; Dubois, WY; Casper, WY |
| O20110708000289 | WY | Part a Provider - Federally Qualified Health Center (FQHC) | 3375454705 | Practice locations: Dubois, WY |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
5647 US Hwy 26
Dubois, WY 82513-0577
Mailing address
5000 Blackmore Rd
Casper, WY 82609-3345
Phone (307) 233-6000
Other names
- Dubois Medical Clinic
Other providers in Dubois, WY
- Paul T Beisser III
- Christen Shealeen Boyle
- Dubois Assisted Living, Inc
- Dubois Vision Center
- Linda Carol Eckley
- Guardian Flight LLC
- Stacy M Hutchins
All providers in Dubois, WY · Federally Qualified Health Center (FQHC) in Wyoming
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 8, 2024. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.