NPIMap

Organization Active NPI

Memorial Hospital of Converse County

  • Critical Access Hospital
  • Douglas, WY
National Provider Identifier
1326085408
Registry record updated Feb 23, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
06141 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
May 31, 2006
Last updated
Feb 23, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2011

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

Authorized official

Name
Curtis R Dugger
Title
Controller
Phone
(307) 358-2122

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 06141 WY Primary

Addresses

Primary practice location

111 S 5TH St
Douglas, WY 82633-2434

Mailing address

111 S 5TH St
Douglas, WY 82633-2434
Phone (307) 358-2122

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070815000252 WY Part A Provider - Critical Access Hospital 2264340843 Receives reassigned benefits from 102 practitioners
Practice locations: Douglas, WY
O20100930094911 WY DME Supplier - Hospital 2264340843 Practice locations: Douglas, WY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1326085408. Details of each certification follow.

Hospital certification: CCN 531302

Legal name
MEMORIAL HOSPITAL OF CONVERSE COUNTY
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
May 1, 2002
Last certification
Mar 5, 2020
Beds
25
Ownership / control type
Local
Organization structure
GovernmentProprietary
Enrollment address
111 S 5TH St
Douglas, WY 82633-2434

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).

Care Compare: Hospital

Medicare Care Compare
Listed as
Memorial Hospital of Converse CountyCCN 531302 · All quality measures
Overall star rating
4 of 5
Type
Critical Access Hospitals
Ownership
Government - Local
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

111 S 5th St
Fl 4
Douglas, WY 82633
Phone (307) 358-6200

Interoperability endpoints

  • Direct secure messaging: ccapron@direct.mhccwyo.org
  • Direct secure messaging: dengle@direct.mhccwyo.org
  • Direct secure messaging: dmayne@direct.mhccwyo.org
  • Direct secure messaging: jehlert@direct.mhccwyo.org
  • Direct secure messaging: jgrosdidier@direct.mhccwyo.org
  • Direct secure messaging: jgutman@direct.mhccwyo.org
  • Direct secure messaging: jkeller@direct.mhccwyo.org
  • Direct secure messaging: jujohnson@direct.mhccwyo.org
  • Direct secure messaging: kmcmillan@direct.mhccwyo.org
  • Direct secure messaging: kskuza@direct.mhccwyo.org
  • Direct secure messaging: ksokol@direct.mhccwyo.org
  • Direct secure messaging: mcampbell@direct.mhccwyo.org
  • Direct secure messaging: mmajeed@direct.mhccwyo.org
  • Direct secure messaging: rclifford@direct.mhccwyo.org
  • Direct secure messaging: rhagge@direct.mhccwyo.org

Ownership & related parties

All disclosed owners & managing parties 8

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 Direct Ownership Interest Dec 31, 2009 100%
James Cussins Individual W-2 Managing EmployeeCfo Jan 2, 2019
Robert B Kayser Individual Corporate Director Jan 1, 2014
Bobbe K Fitzhugh Individual Corporate Director Jan 1, 2016
Nick Linford Individual Corporate Director Jan 1, 2017
Leslie G Bolln Individual Corporate Director Jan 1, 2014
Charles L Lyford Individual Corporate Director Jan 1, 2014
Matthew M Dammeyer Individual Corporate OfficerChief Executive Officer Oct 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 53Z302 Hospital 5% Or Greater Indirect Ownership Interest (100%) Jan 1, 2014
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

Practitioners 107

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 107

Affiliated clinicians 195

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 195

NPI Registry JSON

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

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1298419200000",
    "number": "1326085408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "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"
        },
        {
            "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": "NO",
        "enumeration_date": "2006-05-31",
        "last_updated": "2011-02-23",
        "status": "A",
        "authorized_official_last_name": "DUGGER",
        "authorized_official_first_name": "CURTIS",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "307-358-2122"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "WY",
            "license": "06141",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Douglas, WY

Sources for this page

Verify at the official NPI Registry.