NPIMap

Individual provider Active NPI

Sally J Whitman, PA-C

  • Medical Physician Assistant
  • Cody, WY
National Provider Identifier
1629034848
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
316 TL Issued in WY
Practice address
721 Sheridan Ave
Ste 220
Cody, WY 82414-3423
Phone
(307) 587-1155
Fax
(307) 587-1166
NPI assigned
Apr 25, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 316 TL WY Primary

Addresses

Primary practice location

721 Sheridan Ave
Ste 220
Cody, WY 82414-3423

Mailing address

721 Sheridan Ave
Ste 220
Cody, WY 82414-3423
Phone (307) 587-1155

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
I20060323000035 WY Practitioner - Physician Assistant 9032127709 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dale R Myers MD PCGroup PAC ID 4789633819, 3 clinicians

Practice addresses (Care Compare)

1613 Stampede Ave
Suite a
Cody, WY 82414-4710

1613 Stampede Ave a
Cody, WY 82414-4710
Phone (307) 587-1155

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
316 TLWYMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Charles G Welch, P.C. 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.

Hospital & facility affiliations 12

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": "1145923200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1629034848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "721 SHERIDAN AVE",
            "address_2": "STE 220",
            "city": "CODY",
            "state": "WY",
            "postal_code": "824143423",
            "telephone_number": "307-587-1155",
            "fax_number": "307-587-1166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "721 SHERIDAN AVE",
            "address_2": "STE 220",
            "city": "CODY",
            "state": "WY",
            "postal_code": "824143423",
            "telephone_number": "307-587-1155",
            "fax_number": "307-587-1166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITMAN",
        "first_name": "SALLY",
        "middle_name": "J",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WY",
            "license": "316 TL",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cody, WY

Sources for this page

Verify at the official NPI Registry.