NPIMap

Organization Active NPI

South Lincoln Hospital District

Doing business as South Lincioln Medical Clinic

  • Rural Health Clinic/Center
  • Kemmerer, WY
National Provider Identifier
1386716710
Registry record updated Oct 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SOUTH LINCOLN HOSPITAL DISTRICT
Doing business as
South Lincioln Medical Clinic
South Lincoln Medical Clinic
Practice address
711 Onyx St
Kemmerer, WY 83101
Phone
(307) 877-4401
Fax
(307) 877-3236
NPI assigned
Nov 14, 2006
Last updated
Oct 24, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2025

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

Authorized official

Name
David Ryerse
Title
Ceo
Phone
(307) 800-8650

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 06-148 WY
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

711 Onyx St
Kemmerer, WY 83101

Mailing address

711 Onyx St
Kemmerer, WY 83101-3214
Phone (307) 877-4401

Other names 2

  • SOUTH LINCIOLN MEDICAL CLINIC Doing business as
  • South Lincoln Medical Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040604000832 WY Part B Supplier - Clinic/Group Practice 2961490057 Receives reassigned benefits from 22 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kemmerer, WY; Rock Springs, WY; Evanston, WY
O20190904002513 WY Part A Provider - Rural Health Clinic 2961490057 Practice locations: Kemmerer, WY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1386716710. Details of each certification follow.

Rural health clinic certification: CCN 533998

Legal name
SOUTH LINCOLN HOSPITAL DISTRICT
Doing business as
SOUTH LINCOLN MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 18, 2020
Last certification
Jan 18, 2020
Ownership / control type
Non-profit – church related
Organization structure
OtherNon-profit
Incorporated
Jan 1, 1960 in WY
Enrollment address
711 Onyx St
Kemmerer, WY 83101-3214
Related CCNs
531315

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 5

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

711 Onyx St
Kemmerer, WY 83101
Phone (307) 877-4401

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
William Ball Individual Corporate DirectorVice President of the Board Jan 2, 2020
Paula Bowling Individual Corporate DirectorBoard Treasurer Jan 2, 2020
Michelle Pollard Individual Corporate DirectorPresident of Board Jan 2, 2020
David Ryerse Individual W-2 Managing EmployeeAd; Jul 12, 2021 100%
Kristina Gordon Individual W-2 Managing EmployeeFinance Controller Jan 1, 2023

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Arrowhead Family MedicineEvanston, WY, CCN 533400 Rural health clinic Operational/Managerial Control (100%) Jan 2, 2020

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 23

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 23

NPI Registry JSON

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1761264000000",
    "number": "1386716710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 ONYX ST",
            "city": "KEMMERER",
            "state": "WY",
            "postal_code": "831013214",
            "telephone_number": "307-877-4401",
            "fax_number": "307-877-3236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 ONYX ST",
            "city": "KEMMERER",
            "state": "WY",
            "postal_code": "83101",
            "telephone_number": "307-877-4401",
            "fax_number": "307-877-3236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH LINCOLN HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2025-10-24",
        "certification_date": "2025-10-24",
        "status": "A",
        "authorized_official_last_name": "RYERSE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "307-800-8650"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "WY",
            "license": "06-148",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SOUTH LINCIOLN MEDICAL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SOUTH LINCIOLN MEDICAL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "South Lincoln Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kemmerer, WY

Sources for this page

Verify at the official NPI Registry.