Individual provider Active NPI

Wyatt Jerome Kramer, PA-C

  • Physician Assistant
  • Cheyenne, WY
National Provider Identifier
1467521955
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
393 Issued in WY
Practice address
6900 Alden Dr
Cheyenne, WY 82005-3906
Phone
(307) 773-2359
NPI assigned
Nov 7, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 393 WY Primary

Addresses

Primary practice location

6900 Alden Dr
Cheyenne, WY 82005-3906

Mailing address

5500 Bishop Blvd
Cheyenne, WY 82009-3320
Phone (307) 772-5387

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100628000178 NE Practitioner - Physician Assistant 5193856672 Reassigns benefits to 3 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Morrill County Community Hospital Physician Assistant CurrentSince Mar 15, 2018 Accepting new patients
Morrill County Community Hospital Current Accepting new patients
Kimball County Hospital CurrentSince May 1, 2015 Accepting new patients

Locations

1313 S St
Bridgeport, NE 69336
Phone (308) 262-1616

1313 S St
#A
Bridgeport, NE 69336
Phone (308) 262-1755

255 W 4th St
Kimball, NE 69145
Phone (308) 235-1951

Interoperability endpoints

  • Direct secure messaging: wyattkramer@mcch.medalliesdirect.net

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1162857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1467521955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 BISHOP BLVD",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820093320",
            "telephone_number": "307-772-5387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6900 ALDEN DR",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820053906",
            "telephone_number": "307-773-2359"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRAMER",
        "first_name": "WYATT",
        "middle_name": "JEROME",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WY",
            "license": "393",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cheyenne, WY

Sources for this page

Verify at the official NPI Registry.