NPIMap

Organization Active NPI

Ivinson Memorial Hospital

  • Rural Acute Care Hospital
  • Laramie, WY
National Provider Identifier
1366626269
Registry record updated Dec 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Acute Care HospitalTaxonomy code 282NR1301X
License
08/186 Issued in WY
Legal business name
IVINSON MEMORIAL HOSPITAL
Doing business as
Ivinson Memorial Hospital
Practice address
255 N. 30TH St
Laramie, WY 82072-5195
Phone
(307) 742-2141
Fax
(307) 742-0678
NPI assigned
Dec 27, 2007
Last updated
Dec 27, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2017

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

Authorized official

Name
James Bands
Title
Cfo
Phone
(307) 755-4603

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Acute Care Hospital 282NR1301X 08/186 WY Primary

Addresses

Primary practice location

255 N. 30TH St
Laramie, WY 82072-5195

Mailing address

255 N. 30TH St
Laramie, WY 82072-5195
Phone (307) 742-2141

Other names 1

  • IVINSON MEMORIAL HOSPITAL Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171107001333 WY Part A Provider - Hospital 8325304447 Practice locations: Laramie, WY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1366626269. Details of each certification follow.

Hospital certification: CCN 53U025

Legal name
IVINSON MEMORIAL HOSPITAL
Organization structure
CorporationNon-profit
Incorporated
Mar 18, 2017 in WY
Enrollment address
255 N 30TH St
Laramie, WY 82072-5140
Hospital Swing-Bed Unit
Hospital subgroups
Swing-bed approved

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).

National Provider Directory

National Provider Directory
Tax ID family
Ivinson Memorial Hospital7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 7

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Catie Ballard Individual Corporate DirectorBoard Member Jan 1, 2018 20%
Dennis Cook Individual Corporate DirectorBoard Member Jan 1, 2018 20%
James G Bands Individual Corporate OfficerCfo Jan 1, 2018 20%
Operational/Managerial ControlCfo Jan 1, 2018 20%
Andrea Lewis Individual W-2 Managing EmployeeRevenue Cycle Director Jan 1, 2018 5%
Doug Faus Individual Corporate OfficerCeo Jan 1, 2018 20%
Ivinson Memorial Hospital Organization, Laramie, WY Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2018 100%
Rick Melone Individual Corporate DirectorBoard Member Jan 1, 2018 20%

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 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Ivinson Memorial HospitalLaramie, WY, CCN 530025 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2018
Ivinson Memorial HospitalLaramie, WY, CCN 53S025 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2018

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 145

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 145

Affiliated clinicians 1

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": "1198713600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1514332800000",
    "number": "1366626269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 N. 30TH ST",
            "city": "LARAMIE",
            "state": "WY",
            "postal_code": "820725195",
            "telephone_number": "307-742-2141",
            "fax_number": "307-742-0678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 N. 30TH ST",
            "city": "LARAMIE",
            "state": "WY",
            "postal_code": "820725195",
            "telephone_number": "307-742-2141",
            "fax_number": "307-742-0678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVINSON MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-27",
        "last_updated": "2017-12-27",
        "status": "A",
        "authorized_official_last_name": "BANDS",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "307-755-4603"
    },
    "taxonomies": [
        {
            "code": "282NR1301X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Rural",
            "state": "WY",
            "license": "08/186",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "IVINSON MEMORIAL HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Laramie, WY

Sources for this page

Verify at the official NPI Registry.