NPIMap

Organization Active NPI

Memorial Hospital of Carbon County

  • Family Medicine Physician
  • Rawlins, WY
National Provider Identifier
1508900341
Registry record updated Jun 15, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4625A Issued in WY
Legal business name
MEMORIAL HOSPITAL OF CARBON COUNTY
Practice address
2012 W Elm Street
Rawlins, WY 82301
Phone
(307) 324-9098
Fax
(307) 324-6726
NPI assigned
Feb 16, 2007
Organization subpart
Yes
Parent organization
MEMORIAL HOSPITAL OF CARBON COUNTYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 15, 2017

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

Authorized official

Name
Michelle Keplinger
Title
Cfo
Phone
(307) 324-8347

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 4625A WY Primary

Addresses

Primary practice location

2012 W Elm Street
Rawlins, WY 82301

Mailing address

PO Box 944
Rawlins, WY 82301-0944
Phone (307) 324-9098

Other identifiers 3

IdentifierTypeStateIssuer
DD2243OtherWYRR MEDICARE
120726100MedicaidWY
05726001OtherWYBCBS OF WYOMING

Other names 1

  • Wagon Circle Family Medical Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040308000403 WY Part B Supplier - Clinic/Group Practice 9638067176 Receives reassigned benefits from 141 practitioners
4 other NPIs on this enrollment
Practice locations: Saratoga, WY; Rawlins, WY; Hanna, WY

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Part of
Mem Hosp Carbon Co DME

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

1180 College Dr
Rock Springs, WY 82901
Phone (307) 352-8125

Ownership & related parties

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Memorial Hospital of Carbon CountyRawlins, WY, CCN 531316 Hospital Operational/Managerial Control Mar 25, 2010
Memorial Hospital of Carbon CountyRawlins, WY, CCN 53Z316 Hospital Operational/Managerial Control Mar 25, 2010

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 149

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

View all 149

NPI Registry JSON

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

{
    "created_epoch": "1171584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1497484800000",
    "number": "1508900341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 944",
            "city": "RAWLINS",
            "state": "WY",
            "postal_code": "823010944",
            "telephone_number": "307-324-9098",
            "fax_number": "307-324-6726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2012 W ELM STREET",
            "city": "RAWLINS",
            "state": "WY",
            "postal_code": "82301",
            "telephone_number": "307-324-9098",
            "fax_number": "307-324-6726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL HOSPITAL OF CARBON COUNTY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEMORIAL HOSPITAL OF CARBON COUNTY",
        "enumeration_date": "2007-02-16",
        "last_updated": "2017-06-15",
        "status": "A",
        "authorized_official_last_name": "KEPLINGER",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "307-324-8347"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "WY",
            "license": "4625A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DD2243",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "120726100",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF WYOMING",
            "identifier": "05726001",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wagon Circle Family Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rawlins, WY

Sources for this page

Verify at the official NPI Registry.