Individual provider Active NPI

Andrew Brent Rose, M.D.

  • Pediatrics Physician
  • Cheyenne, WY
National Provider Identifier
1396998530
Registry record updated Nov 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
8747A Issued in WY
Practice address
2301 House Ave
Suite 405
Cheyenne, WY 82001-3176
Phone
(307) 635-7961
NPI assigned
Oct 31, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 8747A WY Primary

Addresses

Primary practice location

2301 House Ave
Suite 405
Cheyenne, WY 82001-3176

Mailing address

2301 House Ave
Suite 405
Cheyenne, WY 82001-3176
Phone (307) 286-7176

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address arose3229@direct.crmcwy.org Health Information Exchange (HIE) Memorial Hospital of Laramie County
Direct Messaging Address arose3229@direct.crmcwy.org Direct Memorial Hospital of Laramie County

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211026001969 WY Practitioner - Pediatric Medicine 7618365503 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
8747AWYMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cheyenne Regional Physicians Group, LLC CurrentSince Oct 25, 2021 Accepting new patients
Cheyenne Children's Clinic, PC Pediatrics Past Accepting new patients

Locations

2301 House Ave
Ste 405
Cheyenne, WY 82001
Phone (307) 635-7961

4116 Laramie St
Cheyenne, WY 82001
Phone (307) 634-9311

214 E 23rd St
Cheyenne, WY 82001
Phone (307) 324-2221

Interoperability endpoints

  • Direct secure messaging: arose3229@direct.crmcwy.org

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1225411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667433600000",
    "number": "1396998530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 HOUSE AVE",
            "address_2": "SUITE 405",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820013176",
            "telephone_number": "307-286-7176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 HOUSE AVE",
            "address_2": "SUITE 405",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820013176",
            "telephone_number": "307-635-7961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSE",
        "first_name": "ANDREW",
        "middle_name": "BRENT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-10-31",
        "last_updated": "2022-11-03",
        "certification_date": "2022-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WY",
            "license": "8747A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "arose3229@direct.crmcwy.org",
            "affiliation": "Y",
            "endpointDescription": "CRMC Direct Address",
            "affiliationName": "Memorial Hospital of Laramie County",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "214 E 23rd St",
            "city": "Cheyenne",
            "state": "WY",
            "country_code": "US",
            "postal_code": "820013748",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "arose3229@direct.crmcwy.org",
            "affiliation": "Y",
            "endpointDescription": "CRMC Direct Address",
            "affiliationName": "Memorial Hospital of Laramie County",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "214 E 23rd St",
            "city": "Cheyenne",
            "state": "WY",
            "country_code": "US",
            "postal_code": "820013748",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Cheyenne, WY

Sources for this page

Verify at the official NPI Registry.