Red Rock Family Practice, Inc

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

RED ROCK FAMILY PRACTICE, INC

Practice address

120 N C Ave
Thermopolis, WY 82443-2410

Phone

(307) 864-5534

Fax

(307) 864-9470

NPI assigned

Mar 2, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Wade Travis Bomengen, M.D.

Title

Owner

Phone

(307) 864-5534

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Change-of-ownership history 1

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

• Hot Springs County Hospital District

  • Rural Health Clinic/Center
  • Thermopolis, WY
  • NPI 1245747872

  Sold to, 2017-12-07

  CMS change of ownership

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

{
    "created_epoch": "1141257600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1514505600000",
    "number": "1316914922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 N C AVE",
            "city": "THERMOPOLIS",
            "state": "WY",
            "postal_code": "824432410",
            "telephone_number": "307-864-5534",
            "fax_number": "307-864-9470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 N C AVE",
            "city": "THERMOPOLIS",
            "state": "WY",
            "postal_code": "824432410",
            "telephone_number": "307-864-5534",
            "fax_number": "307-864-9470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RED ROCK FAMILY PRACTICE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-02",
        "last_updated": "2017-12-29",
        "status": "A",
        "authorized_official_last_name": "BOMENGEN",
        "authorized_official_first_name": "WADE",
        "authorized_official_middle_name": "TRAVIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "307-864-5534",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "116973401",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Leif Andrew Polson, D.D.S
• Roger Pomeroy
• Leila H Porath, PT
• Thomas E Radosevich, M.D.
• Michael J Rawlings
• Red Rock Family Practice, PC
• William Dwight Robinson, DDS
• Kevin James Ryan, CRNA
• Ryte Rehabilitation LLC
• Katherine N Saltz, MS, NCC LPC

• Rural Health Clinic/Center in Thermopolis, WY
• Providers in Thermopolis, WY by specialty
• Rural Health Clinic/Center in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.