Active NPI
Lori J. Wortham, PA-C
- Medical Physician Assistant
- Casper, WY
National Provider Identifier
1558378372
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 399
- Practice address
- 940 E 3Rd St Ste 215
Casper, WY 82601-3251 - Phone
- (307) 237-5510
- Fax
- (307) 237-0607
- NPI assigned
- Aug 2, 2006
- Last updated
- Mar 22, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA450 | ID | |
| Medical Physician Assistant | 363AM0700X | 399 | WY | Primary |
Addresses
Primary practice location
940 E 3Rd St Ste 215
Casper, WY 82601-3251
Mailing address
940 E 3Rd St Ste 215
Casper, WY 82601-3251
Phone (307) 237-5510
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 806739400 | Medicaid | ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 399 | WY | MD | Clinical Neuropsychologist |
| PA450 | ID | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Medi Horizons Inc | Past | Accepting new patients | |
| Peak Emergency Physicians LLC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Emergency Medicine Physician
- Douglas, WY
- NPI 1306187737
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1300752000000",
"number": "1558378372",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "940 E 3RD ST STE 215",
"city": "CASPER",
"state": "WY",
"postal_code": "826013251",
"telephone_number": "307-237-5510",
"fax_number": "307-237-0607"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "940 E 3RD ST STE 215",
"city": "CASPER",
"state": "WY",
"postal_code": "826013251",
"telephone_number": "307-237-5510",
"fax_number": "307-237-0607"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WORTHAM",
"first_name": "LORI",
"middle_name": "J.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-02",
"last_updated": "2011-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "ID",
"license": "PA450",
"primary": false
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "WY",
"license": "399",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "806739400",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Casper, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.