NPIMap

Organization Active NPI

Community Health Center of Central Wyoming, Inc.

  • Federally Qualified Health Center (FQHC)
  • Casper, WY
National Provider Identifier
1447480561
Registry record updated Mar 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
COMMUNITY HEALTH CENTER OF CENTRAL WYOMING, INC.
Practice address
5000 Blackmore Rd
Casper, WY 82609-3345
Phone
(307) 233-6000
NPI assigned
Jul 23, 2009
Last updated
Mar 8, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2024

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

Authorized official

Name
Amanda Sisco
Title
Revenue Cycle Manager
Phone
(307) 233-6000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

5000 Blackmore Rd
Casper, WY 82609-3345

Mailing address

5000 Blackmore Rd
Casper, WY 82609-3345
Phone (307) 233-6000

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031105000279 WY Part B Supplier - Clinic/Group Practice 3375454705 Receives reassigned benefits from 41 practitioners
5 other NPIs on this enrollment
Practice locations: Lander, WY; Riverton, WY; Dubois, WY; Casper, WY
O20090430000452 WY Part A Provider - Federally Qualified Health Center (FQHC) 3375454705 Practice locations: Casper, WY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1447480561. Details of each certification follow.

Federally qualified health center certification: CCN 531812

Legal name
COMMUNITY HEALTH CENTER OF CENTRAL WYOMING INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 1, 2009
Last certification
May 1, 2009
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 1, 1999 in WY
Enrollment address
5000 Blackmore Rd
Casper, WY 82609-3345
Related CCNs
531804

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory

Locations

1035 Rose Ln
Riverton, WY 82501
Phone (307) 463-6300

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
Evan Condelario Individual Corporate Director Jan 1, 2022
Sean F Ellis Individual Corporate DirectorVice Charman Feb 24, 2009
John Angst Individual Corporate Director Jan 1, 2019
Josephine Gilpatrick Individual Corporate Director Jan 1, 2020
Danielle Krucheck Individual Corporate Director Jan 1, 2020
Tamra Munsell Individual W-2 Managing Employee Apr 1, 2019
Kevin Lanham Individual Corporate Officer Jan 1, 2020

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Community Health Center of Central Wyoming IncLander, WY, CCN 531829 Federally qualified health center Operational/Managerial Control Apr 1, 2019

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 48

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 48

NPI Registry JSON

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

{
    "created_epoch": "1248307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709856000000",
    "number": "1447480561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5000 BLACKMORE RD",
            "city": "CASPER",
            "state": "WY",
            "postal_code": "826093345",
            "telephone_number": "307-233-6000",
            "fax_number": "307-233-6089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5000 BLACKMORE RD",
            "city": "CASPER",
            "state": "WY",
            "postal_code": "826093345",
            "telephone_number": "307-233-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CENTER OF CENTRAL WYOMING, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-23",
        "last_updated": "2024-03-08",
        "certification_date": "2024-03-08",
        "status": "A",
        "authorized_official_last_name": "SISCO",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "REVENUE CYCLE MANAGER",
        "authorized_official_telephone_number": "307-233-6000"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Casper, WY

Sources for this page

Verify at the official NPI Registry.