NPIMap

Organization Active NPI

Teton County Hospital District

Doing business as St John's Health

  • General Practice Physician
  • Jackson, WY
National Provider Identifier
1487818605
Registry record updated Jan 3, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
15109 Issued in WY
Legal business name
TETON COUNTY HOSPITAL DISTRICT
Doing business as
St John's Health
St John's Medical Center
Practice address
625 E Broadway Ave
Jackson, WY 83001-8642
Phone
(307) 733-3636
Fax
(877) 205-2024
NPI assigned
Jul 16, 2008
Last updated
Jan 3, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
TETON COUNTY HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 3, 2026

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

Authorized official

Name
Mitchell C Watson
Title
Chief Financial Officer
Phone
(307) 739-7526

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Hospital Unit 273Y00000X
General Practice Physician 208D00000X 15109 WY Primary

Addresses

Primary practice location

625 E Broadway Ave
Jackson, WY 83001-8642

Mailing address

PO Box 428
Jackson, WY 83001-0428
Phone (307) 733-3636

Other identifiers 2

IdentifierTypeStateIssuer
1062999-09MedicaidWY
806430200MedicaidID

Other names 2

  • St John's Health Doing business as
  • St John's Medical Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Ability Network

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040308000954 WY Part B Supplier - Clinic/Group Practice 4880582295 Receives reassigned benefits from 131 practitioners
2 other NPIs on this enrollment
Practice locations: Wilson, WY; Teton Village, WY; Pinedale, WY; Jackson, WY; Afton, WY

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Part of
St Johns Hospital

Locations

175 N 1st St
Lander, WY 82520
Phone (307) 332-2189

1005 College View Dr
Riverton, WY 82501
Phone (307) 857-3486

1035 Rose Ln
#B
Riverton, WY 82501
Phone (307) 733-8070

Ownership & related parties

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
St Johns Med Center/Or St Johns HealthJackson, WY, CCN 530015 Hospital Other May 23, 2007
St Johns Medical CenterJackson, WY, CCN 53U015 Hospital Operational/Managerial Control Jun 13, 2014
St Johns Health Sage LivingJackson, WY, CCN 535046 Skilled nursing facility Adp of the SNF Mar 13, 2025
St. John's Home CareJackson, WY, CCN 537063 Home health agency Operational/Managerial Control (100%) Apr 27, 2010
St. John's HospiceJackson, WY, CCN 531504 Hospice Operational/Managerial Control (100%) Jan 1, 1970

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 141

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 141

NPI Registry JSON

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

{
    "created_epoch": "1216166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1767398400000",
    "number": "1487818605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 428",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830010428",
            "telephone_number": "307-733-3636",
            "fax_number": "877-205-2024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 E BROADWAY AVE",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830018642",
            "telephone_number": "307-733-3636",
            "fax_number": "877-205-2024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TETON COUNTY HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TETON COUNTY HOSPITAL DISTRICT",
        "enumeration_date": "2008-07-16",
        "last_updated": "2026-01-03",
        "certification_date": "2026-01-03",
        "status": "A",
        "authorized_official_last_name": "WATSON",
        "authorized_official_first_name": "MITCHELL",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "307-739-7526"
    },
    "taxonomies": [
        {
            "code": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "WY",
            "license": "15109",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1062999-09",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806430200",
            "state": "ID"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "284 Merchant St",
            "city": "Ste Genevieve",
            "state": "MO",
            "country_code": "US",
            "postal_code": "636701610",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "St John's Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St John's Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, WY

Sources for this page

Verify at the official NPI Registry.