Lillian Regina Devine, NP-C
Individual provider Active NPI Primary Care Nurse Practitioner · Cheyenne, WY
NPI 1609461599 · NPPES record last updated Sep 27, 2021
Key facts
- NPI
- 1609461599
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Primary Care Nurse Practitioner 363LP2300X
- License
- 46259 (WY)
- Practice address
- 5050 Powderhouse Rd
Cheyenne, WY 82009-4800 - Phone
- (307) 634-1311
- Fax
- (307) 634-1271
- NPI assigned
- Mar 3, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 18
Medicare Care Compare profile
- 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 LLC
Practice addresses (Care Compare)
5050 Powderhouse Rd
Cheyenne, WY 82009-4800
Phone (307) 634-1311
Hospital & facility affiliations
- Eden Home Health
- Enhabit Home Health
- Poudre Valley Hospital
- Cheyenne Regional Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210928003534 | WY | Practitioner - Nurse Practitioner | 3375940687 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 46259 | WY | MD | Primary Care Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Poudre Valley Medical Group, LLC | Current |
Accepting new patients |
Locations
2695 Rocky Mountain Ave
Ste 150
Loveland, CO 80538
Phone (970) 624-2412
5050 Powderhouse Rd
Cheyenne, WY 82009
Phone (307) 634-1311
3116 Willett Dr
Laramie, WY 82072
Phone (307) 742-6319
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gerontology Registered Nurse | 163WG0600X | 46259 | WY | |
| Primary Care Nurse Practitioner | 363LP2300X | 46259 | WY | Yes |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PENDING | Medicaid | WY |
Other providers in Cheyenne, WY
- Kathleen Ann Derr
- Anita Carolyn Deselms
- Kirstin Jo Deselms
- Designer Smiles LLC
- Kelsey J Devereaux
- Kanti Devkota
- Tracy Dicamillo
- Austin Robert Dickerson
- Felicia Ann Dickerson
- Lori Dickerson
All providers in Cheyenne, WY · Primary Care Nurse Practitioner in Wyoming
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 27, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.