Individual provider Active NPI

Byron James Peterson

  • Certified Registered Nurse Anesthetist
  • Gillette, WY
National Provider Identifier
1568716280
Registry record updated Dec 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
0024170570 Issued in VA
Practice address
501 S Burma Ave
Gillette, WY 82716-3426
Phone
(307) 688-1000
NPI assigned
Nov 2, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 0024170570 VA Primary

Addresses

Primary practice location

501 S Burma Ave
Gillette, WY 82716-3426

Mailing address

501 S Burma Ave
Gillette, WY 82716-3426
Phone (307) 688-1000

Other practice location 1

620 John Paul Jones Cir
Portsmouth, VA 23708-2111
Phone (757) 371-9239

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cchwyo@cchwyo.sdhealthlink.net Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, VA, CO, WY4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
I20140508001241 NC Practitioner - Certified Registered Nurse Anesthetist (Crna) 4688807092 Reassigns benefits to 1 organization
I20161227000316 VA Practitioner - Certified Registered Nurse Anesthetist (Crna) 4688807092 Reassigns benefits to 2 organizations
I20191228000278 CO Practitioner - Certified Registered Nurse Anesthetist (Crna) 4688807092 Reassigns benefits to 1 organization
I20200406000629 WY Practitioner - Certified Registered Nurse Anesthetist (Crna) 4688807092 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Campbell County Hospital DistrictGroup PAC ID 2860392529, 128 clinicians
Wyoming Medical Associates LLCGroup PAC ID 2769802552, 12 clinicians

Practice addresses (Care Compare)

501 S Burma Ave
Gillette, WY 82716-3426
Phone (307) 688-1000

51 Town Ctr Dr
Suite 120
Gillette, WY 82718-5521
Phone (307) 682-9962

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Campbell County Hospital District CurrentSince May 1, 2020 Accepting new patients
Glenwood Anesthesia Professionals, PC CurrentSince Nov 13, 2019 Accepting new patients
Campbell County Hospital District CurrentSince May 1, 2020 Accepting new patients
Medstream Anesthesia PLLC Nurse Anesthetist, Certified Registered CurrentSince Sep 26, 2017 Accepting new patients
Campbell County Hospital District Current Accepting new patients
Duplin General Hospital, Incorporated CurrentSince Dec 17, 2013 Accepting new patients
Campbell County Hospital District Current Accepting new patients
Duplin General Hospital, Incorporated CurrentSince Dec 17, 2013 Accepting new patients
SMG Anesthesia Specialists LLC CurrentSince Jan 9, 2017 Accepting new patients

Locations

1906 Blake Ave
Glenwood Springs, CO 81601
Phone (970) 384-7033

401 N Main St
Kenansville, NC 28349
Phone (910) 296-0941

6801 Governor Gc Peery Hwy
Richlands, VA 24641
Phone (276) 523-8600

2025 Glenn Mitchell Dr
Virginia Beach, VA 23456
Phone (757) 507-1000

501 S Burma Ave
Gillette, WY 82716
Phone (307) 682-8811

Organizations & group practices 10

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1351814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608681600000",
    "number": "1568716280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 S BURMA AVE",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827163426",
            "telephone_number": "307-688-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 S BURMA AVE",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827163426",
            "telephone_number": "307-688-1000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "620 John Paul Jones Cir",
            "address_purpose": "LOCATION",
            "city": "Portsmouth",
            "state": "VA",
            "postal_code": "237082111",
            "country_code": "US",
            "telephone_number": "757-371-9239",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "BYRON",
        "middle_name": "JAMES",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-11-02",
        "last_updated": "2020-12-23",
        "certification_date": "2020-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "VA",
            "license": "0024170570",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cchwyo@cchwyo.sdhealthlink.net",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "501 S Burma Ave",
            "city": "Gillette",
            "state": "WY",
            "country_code": "US",
            "postal_code": "827163426",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Gillette, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.