NPIMap

Individual provider Active NPI

Tracy Wickersham-Frey, PA-C

  • Medical Physician Assistant
  • Gillette, WY
National Provider Identifier
1447653456
Registry record updated Dec 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
Practice address
501 S Burma Ave
Gillette, WY 82716-3426
Phone
(307) 688-1000
NPI assigned
Oct 4, 2014
Last updated
Dec 27, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X Primary

Addresses

Primary practice location

501 S Burma Ave
Gillette, WY 82716-3426

Mailing address

1121 Washington Blvd
Newcastle, WY 82701-2968
Phone (307) 746-3582

Other practice location 1

1121 Washington Blvd
Newcastle, WY 82701-2968
Phone (307) 746-3582

Other practice location 2

1401 W 5th St
Sheridan, WY 82801-2705
Phone (307) 672-1100

Other identifiers 1

IdentifierTypeStateIssuer
PA618OtherWYPA LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150505000395 WY Practitioner - Physician Assistant 0042539595 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Big Horn Health NetworkGroup PAC ID 1254476484, 84 clinicians
Campbell County Hospital DistrictGroup PAC ID 2860392529, 128 clinicians

Practice addresses (Care Compare)

1401 W 5TH St
Sheridan, WY 82801-2705
Phone (307) 672-1000

1470 Sugarland Dr
Suite 1
Sheridan, WY 82801-5774
Phone (307) 673-2411

501 S Burma Ave
Gillette, WY 82716-3426
Phone (307) 688-1000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.21 of 100Reported as group
Quality
80.49
Promoting interoperability
94
Improvement activities
40
Cost
68.55

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Hospital of Sheridan County CurrentSince Jan 1, 2024 Accepting new patients
Memorial Hospital of Sheridan County CurrentSince Jan 1, 2024 Accepting new patients
Campbell County Hospital District Current Accepting new patients
Campbell County Hospital District, CurrentSince Mar 26, 2018 Accepting new patients
Campbell County Hospital District CurrentSince Mar 26, 2018 Accepting new patients
Campbell County Hospital District Past Accepting new patients

Locations

501 S Burma Ave
Gillette, WY 82716
Phone (307) 682-8811

501 S Burma Ave
Fl 3
Gillette, WY 82716
Phone (307) 688-3636

1333 W 5th St
Ste 110
Sheridan, WY 82801
Phone (307) 675-4610

1401 W 5th St
Sheridan, WY 82801
Phone (307) 672-1000

Organizations & group practices 8

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

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1412380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703635200000",
    "number": "1447653456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1121 WASHINGTON BLVD",
            "city": "NEWCASTLE",
            "state": "WY",
            "postal_code": "827012968",
            "telephone_number": "307-746-3582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 S BURMA AVE",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827163426",
            "telephone_number": "307-688-1000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1121 Washington Blvd",
            "address_purpose": "LOCATION",
            "city": "Newcastle",
            "state": "WY",
            "postal_code": "827012968",
            "country_code": "US",
            "telephone_number": "307-746-3582",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1401 W 5th St",
            "address_purpose": "LOCATION",
            "city": "Sheridan",
            "state": "WY",
            "postal_code": "828012705",
            "country_code": "US",
            "telephone_number": "307-672-1100",
            "fax_number": "307-672-1145",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WICKERSHAM-FREY",
        "first_name": "TRACY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-04",
        "last_updated": "2023-12-27",
        "certification_date": "2023-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA LICENSE",
            "identifier": "PA618",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gillette, WY

Sources for this page

Verify at the official NPI Registry.