NPIMap

Organization Active NPI

Evanston Hospital Corporation

  • Family Medicine Physician
  • Lyman, WY
National Provider Identifier
1366989014
Registry record updated Sep 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
EVANSTON HOSPITAL CORPORATION
Practice address
107 N Main St.
Lyman, WY 82937-0001
Phone
(307) 787-3313
NPI assigned
Jan 19, 2017
Last updated
Sep 20, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2018

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

Authorized official

Name
Jeremy Davis
Title
Ceo
Phone
(307) 783-8255

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

107 N Main St.
Lyman, WY 82937-0001

Mailing address

PO Box 5009
Brentwood, TN 37024-5009
Phone (615) 221-1400

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040609001235 WY Part B Supplier - Clinic/Group Practice 7113900358 Receives reassigned benefits from 27 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Evanston, WY; Lyman, WY

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Bridger Valley Family P3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Practitioners & affiliated clinicians

Practitioners 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1484784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1537401600000",
    "number": "1366989014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5009",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370245009",
            "telephone_number": "615-221-1400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 N MAIN ST.",
            "city": "LYMAN",
            "state": "WY",
            "postal_code": "829370001",
            "telephone_number": "307-787-3313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVANSTON HOSPITAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-19",
        "last_updated": "2018-09-20",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "307-783-8255"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lyman, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2018; 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.