Active NPI
Evanston Hospital Corporation
Doing business as Evanston Regional Hospital
- Medicare Defined Swing Bed Hospital Unit
- Evanston, WY
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medicare Defined Swing Bed Hospital Unit
- License
- 06-165
- Legal business name
- EVANSTON HOSPITAL CORPORATION
- Doing business as
- Evanston Regional Hospital
- Practice address
- 190 Arrowhead Dr
Evanston, WY 82930-9266 - Phone
- (307) 789-3636
- Fax
- (307) 783-8167
- NPI assigned
- Feb 2, 2006
- Last updated
- Sep 3, 2020
- Organization subpart
- Yes
- Parent organization
- EVANSTON HOSPITAL CORPORATION
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Randy Michael Cooper
- Title
- SVP Finance Operations/Ao
- Phone
- (615) 221-3840
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medicare Defined Swing Bed Hospital Unit | 275N00000X | 06-165 | WY | Primary |
Addresses
Primary practice location
190 Arrowhead Dr
Evanston, WY 82930-9266
Mailing address
PO Box 6000 File 73783
San Francisco, CA 94160-0001
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 41376 | Other | BCBS | |
| 114835406 | Medicaid | WY |
Other names 1
- Evanston Regional Hospital
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20250407002179 | WY | Part A Provider - Critical Access Hospital | 7113900358 |
1 other NPI on this enrollment Practice locations: Evanston, WY |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1356313506. Details of each certification follow.
Hospital certification: CCN 53Z319
- Legal name
- EVANSTON HOSPITAL CORPORATION
- Doing business as
- EVANSTON REGIONAL HOSPITAL
- Organization structure
- Corporation
- Enrollment address
- 190 Arrowhead Dr
Evanston, WY 82930-9266
Related certifications (CCN) 1
Facilities connected through Provider of Services related, parent or unit certification numbers.
-
dba Evanston Regional Hospital
- General Acute Care Hospital
- Evanston, WY
- NPI 1639140015
Unit of hospital
Other NPIs with the same Medicare PAC ID 5
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
- Certified Registered Nurse Anesthetist
- Evanston, WY
- NPI 1013288836
7113900358
-
dba Bridger Valley Medical Group
- Rural Health Clinic/Center
- Lyman, WY
- NPI 1134666944
7113900358
-
dba Evanston Dialysis Center
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Evanston, WY
- NPI 1255304051
7113900358
-
dba Bridger Valley Medical Group
- Rural Health Clinic/Center
- Mountain View, WY
- NPI 1427595271
7113900358
-
dba Evanston Regional Hospital
- General Acute Care Hospital
- Evanston, WY
- NPI 1639140015
7113900358
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
dba Evanston Regional Hospital
- General Acute Care Hospital
- Evanston, WY
- NPI 1639140015
O20250407002179
National Provider Directory
National Provider Directory- Part of
- Bridger Valley Family P
Ownership & related parties
All disclosed owners & managing parties 10
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Henry Kunath | Corporate Officer | Sep 6, 2023 | |
| Corporate Director | Sep 6, 2023 | ||
| Anthony Roberts | Corporate Officer | May 11, 2026 | |
| Corporate Director | May 11, 2026 | ||
| Christopher M Harrison | Corporate Officer | Apr 1, 2025 | |
| Corporate Director | Apr 1, 2025 | ||
| Quorum Health Corporation | 5% Or Greater Direct Ownership Interest | Apr 29, 2016 | 100% |
| Gtam Onshore Blocker 2 LLC | 5% Or Greater Indirect Ownership Interest | Dec 20, 2023 | 19.34% |
| Goldentree Distressed Onshore Master Fund III LP | 5% Or Greater Indirect Ownership Interest | Aug 5, 2020 | 13.07% |
| Laura Fey | Corporate Director | Aug 27, 2018 | |
| W-2 Managing Employee | Aug 27, 2018 | ||
| Goldentree Select Offshore Intermediate Fund LP | 5% Or Greater Indirect Ownership Interest | Jul 7, 2020 | 82.37% |
| Goldentree Distressed Master Fund III LTD | 5% Or Greater Indirect Ownership Interest | Jul 7, 2020 | 100% |
| Quincy Health LLC | 5% Or Greater Indirect Ownership Interest | Jul 7, 2020 | 100% |
Facilities with the same owner 32
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
dba Bridger Valley Medical Group
- Rural Health Clinic/Center
- Lyman, WY
- NPI 1134666944
Goldentree Distressed Master Fund III LTD, Goldentree Distressed Onshore Master Fund III LP, Goldentree Select Offshore Intermediate Fund LP, Quincy Health LLC, Quorum Health Corporation
-
dba Bridger Valley Medical Group
- Rural Health Clinic/Center
- Mountain View, WY
- NPI 1427595271
Goldentree Distressed Master Fund III LTD, Goldentree Distressed Onshore Master Fund III LP, Goldentree Select Offshore Intermediate Fund LP, Quincy Health LLC, Quorum Health Corporation
-
dba Evanston Regional Hospital
- General Acute Care Hospital
- Evanston, WY
- NPI 1639140015
Goldentree Distressed Master Fund III LTD, Goldentree Distressed Onshore Master Fund III LP, Goldentree Select Offshore Intermediate Fund LP, Gtam Onshore Blocker 2 LLC, Quincy Health LLC, Quorum Health Corporation
-
- Rural Health Clinic/Center
- Alpine, TX
- NPI 1275988669
Goldentree Distressed Master Fund III LTD, Goldentree Distressed Onshore Master Fund III LP, Goldentree Select Offshore Intermediate Fund LP, Gtam Onshore Blocker 2 LLC, Quincy Health LLC, Quorum Health Corporation
-
dba Big Bend Regional Medical Center
- Critical Access Hospital
- Alpine, TX
- NPI 1356312243
Goldentree Distressed Master Fund III LTD, Goldentree Distressed Onshore Master Fund III LP, Goldentree Select Offshore Intermediate Fund LP, Gtam Onshore Blocker 2 LLC, Quincy Health LLC, Quorum Health Corporation
-
dba Big Bend Regional Medical Center
- Medicare Defined Swing Bed Hospital Unit
- Alpine, TX
- NPI 1689773756
Goldentree Distressed Master Fund III LTD, Goldentree Distressed Onshore Master Fund III LP, Goldentree Select Offshore Intermediate Fund LP, Gtam Onshore Blocker 2 LLC, Quincy Health LLC, Quorum Health Corporation
-
dba Scenic Mountain Medical Center
- General Acute Care Hospital
- Big Spring, TX
- NPI 1336976034
Goldentree Distressed Master Fund III LTD, Goldentree Distressed Onshore Master Fund III LP, Goldentree Select Offshore Intermediate Fund LP, Gtam Onshore Blocker 2 LLC, Quincy Health LLC, Quorum Health Corporation
-
dba Scenic Mountain Medical Center
- Psychiatric Hospital Unit
- Big Spring, TX
- NPI 1770310476
Goldentree Distressed Master Fund III LTD, Goldentree Distressed Onshore Master Fund III LP, Goldentree Select Offshore Intermediate Fund LP, Gtam Onshore Blocker 2 LLC, Quincy Health LLC, Quorum Health Corporation
-
dba Mimbres Valley Medical Group
- Rural Health Clinic/Center
- Deming, NM
- NPI 1134526221
Goldentree Distressed Master Fund III LTD, Goldentree Distressed Onshore Master Fund III LP, Goldentree Select Offshore Intermediate Fund LP, Gtam Onshore Blocker 2 LLC, Quincy Health LLC, Quorum Health Corporation
-
dba Mimbres Memorial Hospital
- Medicare Defined Swing Bed Hospital Unit
- Deming, NM
- NPI 1710196571
Goldentree Distressed Master Fund III LTD, Goldentree Distressed Onshore Master Fund III LP, Goldentree Select Offshore Intermediate Fund LP, Gtam Onshore Blocker 2 LLC, Quincy Health LLC, Quorum Health Corporation
-
dba Mimbres Memorial Hospital
- Critical Access Hospital
- Deming, NM
- NPI 1891075446
Goldentree Distressed Master Fund III LTD, Goldentree Distressed Onshore Master Fund III LP, Goldentree Select Offshore Intermediate Fund LP, Gtam Onshore Blocker 2 LLC, Quincy Health LLC, Quorum Health Corporation
-
dba Forrest City Medical Center
- General Acute Care Hospital
- Forrest City, AR
- NPI 1811912009
Goldentree Distressed Master Fund III LTD, Goldentree Distressed Onshore Master Fund III LP, Goldentree Select Offshore Intermediate Fund LP, Gtam Onshore Blocker 2 LLC, Quincy Health LLC, Quorum Health Corporation
Practitioners & affiliated clinicians
Affiliated clinicians 3
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": "1138838400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1599091200000",
"number": "1356313506",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 6000 FILE 73783",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941600001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "190 ARROWHEAD DR",
"city": "EVANSTON",
"state": "WY",
"postal_code": "829309266",
"telephone_number": "307-789-3636",
"fax_number": "307-783-8167"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "EVANSTON HOSPITAL CORPORATION",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "EVANSTON HOSPITAL CORPORATION",
"enumeration_date": "2006-02-02",
"last_updated": "2020-09-03",
"certification_date": "2020-09-03",
"status": "A",
"authorized_official_last_name": "COOPER",
"authorized_official_first_name": "RANDY",
"authorized_official_middle_name": "MICHAEL",
"authorized_official_title_or_position": "SVP FINANCE OPERATIONS/AO",
"authorized_official_telephone_number": "615-221-3840"
},
"taxonomies": [
{
"code": "275N00000X",
"taxonomy_group": "",
"desc": "Medicare Defined Swing Bed Unit",
"state": "WY",
"license": "06-165",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "41376",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "114835406",
"state": "WY"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Evanston Regional Hospital",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Evanston Regional Hospital",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Evanston, WY
- Evanston Dental,LLC
- Evanston Emergency Physicians PLLC
- Evanston Family Foot Care
- Evanston Hospital Corporation
- Evanston Hospital Corporation (Evanston Dialysis Center)
- Evanston Hospital Corporation (Evanston Regional Hospital)
- Evanston Hospital Corporation (Evanston Regional Hosp - ER Dept)
- Evanston Internal Medicine Assoc. (Evanston Internal Medicine Associates)
- Evanston Regional Physicians LLC
- Evanston Surgical Center LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2020; 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.