NPIMap

Organization Active NPI

Gem City Bone & Joint PC

  • Orthopaedic Surgery Physician
  • Laramie, WY
National Provider Identifier
1366412397
Registry record updated Jan 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
GEM CITY BONE & JOINT PC
Practice address
1909 Vista Dr
Laramie, WY 82070-5530
Phone
(307) 745-8851
Fax
(307) 742-0961
NPI assigned
Jan 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2021

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

Authorized official

Name
Jana Suazo
Title
Director of Human Resources
Phone
(307) 745-1415

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Medicine (Neuromusculoskeletal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 204C00000X
Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207X00000X Primary
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081P2900X
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X
Radiology Clinic/Center 261QR0200X
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

1909 Vista Dr
Laramie, WY 82070-5530

Mailing address

1909 Vista Dr
Laramie, WY 82070-5530
Phone (307) 745-8851

Other identifiers 4

IdentifierTypeStateIssuer
106251402MedicaidWY
00832001OtherBCBS
106251400MedicaidWY
38121263MedicaidCO

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031118000791 WY Part B Supplier - Clinic/Group Practice 0244144715 Receives reassigned benefits from 23 practitioners
Practice locations: Laramie, WY; Torrington, WY; Rock Springs, WY; Riverton, WY; Rawlins, WY; Gillette, WY; Cheyenne, WY; Casper, WY
O20100617000847 WY Part B Supplier - Ambulatory Surgical Center 0244144715 Receives reassigned benefits from 2 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Laramie, WY

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

5810 E 2nd St
Casper, WY 82609

7226 Commons Dr
Ste A
Cheyenne, WY 82009
Phone (307) 745-8851

606 23rd St
Rawlins, WY 82301
Phone (307) 324-6002

2002 W Sunset Dr
Riverton, WY 82501
Phone (307) 856-4053

655 Albany Ave
Torrington, WY 82240

Practitioners & affiliated clinicians

Practitioners 31

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1138060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611187200000",
    "number": "1366412397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1909 VISTA DR",
            "city": "LARAMIE",
            "state": "WY",
            "postal_code": "820705530",
            "telephone_number": "307-745-8851",
            "fax_number": "307-742-0961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1909 VISTA DR",
            "city": "LARAMIE",
            "state": "WY",
            "postal_code": "820705530",
            "telephone_number": "307-745-8851",
            "fax_number": "307-742-0961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEM CITY BONE & JOINT PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-24",
        "last_updated": "2021-01-21",
        "certification_date": "2021-01-21",
        "status": "A",
        "authorized_official_last_name": "SUAZO",
        "authorized_official_first_name": "JANA",
        "authorized_official_title_or_position": "DIRECTOR OF HUMAN RESOURCES",
        "authorized_official_telephone_number": "307-745-1415"
    },
    "taxonomies": [
        {
            "code": "204C00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Neuromusculoskeletal Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "106251402",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "00832001",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "106251400",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38121263",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Laramie, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.