Amy R Surdam, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

18161.0312 Issued in WY

Practice address

433 E 19TH St
Cheyenne, WY 82001-4643

Phone

(307) 635-5393

Fax

(307) 635-2199

NPI assigned

Jul 21, 2006

Last updated

Jun 28, 2012By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 5

Other names 1

• Amy R Forkner Former name

Medicare fee-for-service enrollment

Enrolled in WY, CO, TX3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 3

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: amy.surdam.1@22626.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/22626/brand/1/csg/1/fhir/r4

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.

• Instaclinic, LLC

  • Clinic/Center
  • Dallas, TX
  • NPI 1659978401

  CO, WY

  Medicare reassignment NPD Authorized official
• Care United Medical Center of Laramie, LLC

  dba BestMed

  • Multi-Specialty Clinic/Center
  • Laramie, WY
  • NPI 1063720605

  CO

  Medicare reassignment NPD
• Instaclinic LLC

  • Clinic/Center
  • Cheyenne, WY
  • NPI 1487366332
  NPD Authorized official
• Frontier Medical Providers

  • Urgent Care Clinic/Center
  • Cheyenne, WY
  • NPI 1437416443
  NPD
• Medi Horizons Inc

  dba Healthreach

  • Family Medicine Physician
  • Cheyenne, WY
  • NPI 1003836834
  NPD (past)
• Medihorizons Inc

  dba Cheyenne Family Medicine

  • Family Medicine Physician
  • Cheyenne, WY
  • NPI 1154342921
  NPD (past)

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340841600000",
    "number": "1629099312",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 20170",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820037004",
            "telephone_number": "307-635-5393",
            "fax_number": "307-635-2199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "433 E 19TH ST",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820014643",
            "telephone_number": "307-635-5393",
            "fax_number": "307-635-2199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SURDAM",
        "first_name": "AMY",
        "middle_name": "R",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-21",
        "last_updated": "2012-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WY",
            "license": "18161.0312",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WPS TRIWEST",
            "identifier": "82009A055",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00251860",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "313763",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121544200",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WINHEALTH PARTNERS",
            "identifier": "23339",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMY",
            "last_name": "FORKNER",
            "middle_name": "R",
            "credential": "NO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Sandra K Surbrugg, MD
• Daniel E Surdam, MD
• Linnaea Despain Sutphin
• Leona L. Sutton, R.N.
• Kimberley Svoboda, LPN
• Patricia Ann Swan-Smith, LCPC, LPC

• Nurse Practitioner in Cheyenne, WY
• Providers in Cheyenne, WY by specialty
• Nurse Practitioner in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.