NPIMap

Individual provider Active NPI

Lillian Regina Devine, NP-C

  • Primary Care Nurse Practitioner
  • Cheyenne, WY
National Provider Identifier
1609461599
Registry record updated Sep 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
46259 Issued in WY
Practice address
5050 Powderhouse Rd
Cheyenne, WY 82009-4800
Phone
(307) 634-1311
Fax
(307) 634-1271
NPI assigned
Mar 3, 2021
Last updated
Sep 27, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse Practitioner 363LP2300X 46259 WY Primary
Gerontology Registered Nurse 163WG0600X 46259 WY

Addresses

Primary practice location

5050 Powderhouse Rd
Cheyenne, WY 82009-4800

Mailing address

5050 Powderhouse Rd
Cheyenne, WY 82009-4800
Phone (307) 634-1311

Other identifiers 1

IdentifierTypeStateIssuer
PENDINGMedicaidWY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210928003534 WY Practitioner - Nurse Practitioner 3375940687 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Poudre Valley Medical Group LLCGroup PAC ID 9638208549, 2,425 clinicians

Practice addresses (Care Compare)

5050 Powderhouse Rd
Cheyenne, WY 82009-4800
Phone (307) 634-1311

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
46259WYMDGerontology Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Poudre Valley Medical Group, LLC CurrentSince Oct 4, 2021 Accepting new patients

Locations

2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2403

5050 Powderhouse Rd
Cheyenne, WY 82009
Phone (307) 634-1311

3116 Willett Dr
Laramie, WY 82072
Phone (307) 742-6319

Organizations & group practices 1

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.

Hospital & facility affiliations 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1614729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632700800000",
    "number": "1609461599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5050 POWDERHOUSE RD",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820094800",
            "telephone_number": "307-634-1311",
            "fax_number": "307-634-1271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5050 POWDERHOUSE RD",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820094800",
            "telephone_number": "307-634-1311",
            "fax_number": "307-634-1271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEVINE",
        "first_name": "LILLIAN",
        "middle_name": "REGINA",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-03",
        "last_updated": "2021-09-27",
        "certification_date": "2021-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "WY",
            "license": "46259",
            "primary": true
        },
        {
            "code": "163WG0600X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Gerontology",
            "state": "WY",
            "license": "46259",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cheyenne, WY

Sources for this page

Verify at the official NPI Registry.