David K. Custis, PA-C
Individual provider Active NPI Physician Assistant · Gillette, WY
NPI 1477516540 · NPPES record last updated Jul 29, 2026
Key facts
- NPI
- 1477516540
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA832 (WY)
- Practice address
- 501 S Burma Ave
Gillette, WY 82716-3426 - Phone
- (307) 688-3636
- Fax
- (307) 688-7920
- NPI assigned
- Apr 10, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 14
Hospital & facility affiliations 14
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- University of North Dakota School of Medicine, 1982
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Campbell County Hospital District
Practice addresses (Care Compare)
501 S Burma Ave
Gillette, WY 82716-3426
Phone (307) 688-1000
Hospital & facility affiliations
- Campbell County Health
- Monument Health Rapid City Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 93.78 of 100
- Quality
- 80.38
- Promoting interoperability
- 100
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190917002845 | WY | Practitioner - Physician Assistant | 6305972571 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0123 | SD | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Campbell County Hospital District | Current |
Accepting new patients | |
| Monument Health Rapid City Hospital, Inc | Current |
Accepting new patients | |
| Campbell County Hospital District | Current |
Accepting new patients | |
| Campbell County Hospital District | Current | Accepting new patients | |
| Campbell County Hospital District | Past | Accepting new patients |
Locations
640 Flormann St
Ste 300
Rapid City, SD 57701
Phone (605) 718-3300
353 Fairmont Blvd
Rapid City, SD 57701
Phone (605) 719-1000
501 S Burma Ave
Fl 3
Gillette, WY 82716
Phone (307) 688-3636
501 S Burma Ave
Gillette, WY 82716
Phone (307) 682-8811
Interoperability endpoints
- dcustis.7929@regionalhealth.sdhealthlink.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA832 | WY | Yes |
Addresses
Primary practice location
501 S Burma Ave
Gillette, WY 82716-3426
Mailing address
PO Box 3011
Gillette, WY 82717-3011
Phone (307) 688-1000
NPI Registry JSON
{
"created_epoch": "1144627200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1785283200000",
"number": "1477516540",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3011",
"city": "GILLETTE",
"state": "WY",
"postal_code": "827173011",
"telephone_number": "307-688-1000"
},
{
"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": "307-688-3636",
"fax_number": "307-688-7920"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CUSTIS",
"first_name": "DAVID",
"middle_name": "K.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-10",
"last_updated": "2026-07-29",
"certification_date": "2026-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WY",
"license": "PA832",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gillette, WY
- Kevyann Cowley
- Sally Joy Craig
- Jessi Rae Crain
- Misty Cummings
- Karla Marie Curtis
- Michelle Daigle
- Barbara Lynne Daley
- Daniel L Morin DDS Ms PC
- Kristi Lynn David
- Daniel Davidovich Young
All providers in Gillette, WY · Physician Assistant in Wyoming
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 29, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.