NPIMap

Organization Active NPI

Riverton Physician Practices, LLC

Doing business as Evergreen Pediatrics

  • Pediatrics Physician
  • Riverton, WY
National Provider Identifier
1417257155
Registry record updated Oct 28, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
RIVERTON PHYSICIAN PRACTICES, LLC
Doing business as
Evergreen Pediatrics
Practice address
1005 College View Dr
Riverton, WY 82501-2289
Phone
(307) 857-3488
Fax
(307) 857-5215
NPI assigned
Oct 28, 2010
Last updated
Oct 28, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2010

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

Authorized official

Name
Jess N Judy
Title
President
Phone
(615) 372-8500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

1005 College View Dr
Riverton, WY 82501-2289

Mailing address

1005 College View Dr
Riverton, WY 82501-2289
Phone (307) 857-3488

Other names 1

  • Evergreen Pediatrics Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040505000232 WY Part B Supplier - Clinic/Group Practice 8426954496 Receives reassigned benefits from 51 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Riverton, WY; Lander, WY

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory
Tax ID family
Riverton Physician Practices LLC7 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.

Practitioners & affiliated clinicians

Practitioners 3

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": "1288224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288224000000",
    "number": "1417257155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1005 COLLEGE VIEW DR",
            "city": "RIVERTON",
            "state": "WY",
            "postal_code": "825012289",
            "telephone_number": "307-857-3488",
            "fax_number": "307-857-5215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 COLLEGE VIEW DR",
            "city": "RIVERTON",
            "state": "WY",
            "postal_code": "825012289",
            "telephone_number": "307-857-3488",
            "fax_number": "307-857-5215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERTON PHYSICIAN PRACTICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-28",
        "last_updated": "2010-10-28",
        "status": "A",
        "authorized_official_last_name": "JUDY",
        "authorized_official_first_name": "JESS",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "615-372-8500"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreen Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Riverton, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2010; 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.