Ellen Kingdom, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PT909 Issued in WY

Practice address

2301 House Ave Ste 502
Cheyenne, WY 82001-3179

Phone

(307) 635-4131

NPI assigned

Jun 5, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WY

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

Specialty

Physician Assistant

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Cheyenne Urological P CGroup PAC ID 1951293273, 6 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Cheyenne Regional Medical Center Hospital, Cheyenne, WY, CCN 530014

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

• Cheyenne Urological PC

  • Urology Physician
  • Cheyenne, WY
  • NPI 1942388178
  Medicare reassignment Care Compare group

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

• Memorial Hospital of Laramie County

  dba Cheyenne Regional Medical Center

  • General Acute Care Hospital
  • Cheyenne, WY
  • NPI 1285621839
  Care Compare affiliation

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

{
    "created_epoch": "1591315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607040000000",
    "number": "1508480542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 HOUSE AVE STE 502",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820013179",
            "telephone_number": "307-635-4131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 HOUSE AVE STE 502",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820013179",
            "telephone_number": "307-635-4131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KINGDOM",
        "first_name": "ELLEN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-05",
        "last_updated": "2020-12-04",
        "certification_date": "2020-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0006279",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WY",
            "license": "PT909",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• King & Associates LLC
• Gary R King, LPC 1227
• Patricia King
• Rachel King
• Trudy King
• Jessikah Lee Kipf, MS, PPC
• Thomas D Kirk, MA, LPC, PHD
• Tim J. Kirk, RDCS
• Michelle Kirkbride, M.A.,CCC-SLP
• Todd Kirkbride, LPC, NCC

• Physician Assistant in Cheyenne, WY
• Providers in Cheyenne, WY by specialty
• Physician Assistant in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.