Organization Active NPI

Monument Health Network, Inc.

  • Family Medicine Physician
  • Upton, WY
National Provider Identifier
1629457643
Registry record updated Apr 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MONUMENT HEALTH NETWORK, INC.
Practice address
717 Pine Street
Upton, WY 82730-9901
Phone
(307) 468-2302
Fax
(605) 718-7082
NPI assigned
May 22, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2020

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

Authorized official

Name
Thomas Worsley
Title
President Spearfish Hospital
Phone
(605) 644-4091

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

717 Pine Street
Upton, WY 82730-9901

Mailing address

PO Box 860013
Minneapolis, MN 55486-0013
Phone (307) 468-2302

Other names 1

  • Monument Health Upton Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150611001949 WY Part B Supplier - Clinic/Group Practice 5991616427 Receives reassigned benefits from 10 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Gillette, WY

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1432252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586131200000",
    "number": "1629457643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 860013",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554860013",
            "telephone_number": "307-468-2302",
            "fax_number": "605-755-7884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "717 PINE STREET",
            "city": "UPTON",
            "state": "WY",
            "postal_code": "827309901",
            "telephone_number": "307-468-2302",
            "fax_number": "605-718-7082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONUMENT HEALTH NETWORK, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-22",
        "last_updated": "2020-04-06",
        "certification_date": "2020-04-06",
        "status": "A",
        "authorized_official_last_name": "WORSLEY",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "PRESIDENT SPEARFISH HOSPITAL",
        "authorized_official_telephone_number": "605-644-4091"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Monument Health Upton Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Monument Health Upton Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Upton, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.