NPIMap

Organization Active NPI

Grand Anesthesiology Services PC

  • Anesthesiology Physician
  • Jackson, WY
National Provider Identifier
1477567246
Registry record updated Mar 3, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
GRAND ANESTHESIOLOGY SERVICES PC
Practice address
625 E Broadway
Jackson, WY 83001
Phone
(800) 877-7078
Fax
(307) 739-7446
NPI assigned
Jul 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2008

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

Authorized official

Name
Mr. Marc Domsky, D.O.NPI 1821103268
Title
President
Phone
(307) 739-7218

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X Primary

Addresses

Primary practice location

625 E Broadway
Jackson, WY 83001

Mailing address

PO Box 1501
Idaho Falls, ID 83403-1501
Phone (208) 525-2090

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050506000544 WY Part B Supplier - Clinic/Group Practice 3375583586 Receives reassigned benefits from 2 practitioners
Practice locations: Jackson, WY

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1204502400000",
    "number": "1477567246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1501",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834031501",
            "telephone_number": "208-525-2090",
            "fax_number": "208-525-2662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 E BROADWAY",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "83001",
            "telephone_number": "800-877-7078",
            "fax_number": "307-739-7446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND ANESTHESIOLOGY SERVICES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-28",
        "last_updated": "2008-03-03",
        "status": "A",
        "authorized_official_last_name": "DOMSKY",
        "authorized_official_first_name": "MARC",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "307-739-7218",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2008; 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.