Active NPI
Michael Ward Rosenberg, M.D.
- Surgery Physician
- Jackson, WY
National Provider Identifier
1659345221
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 8000A
- Practice address
- 555 E Broadway Ave
Suite #229
Jackson, WY 83001-8640 - Phone
- (307) 739-7690
- Fax
- (307) 739-7644
- NPI assigned
- Feb 13, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 8000A | WY | Primary |
| Surgery Physician | 208600000X | M-10577 | ID | |
| Surgery Physician | 208600000X | 147502 | NY |
Addresses
Primary practice location
555 E Broadway Ave
Suite #229
Jackson, WY 83001-8640
Mailing address
PO Box 428
Jackson, WY 83001-0428
Phone (307) 739-7690
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00953517 | Medicaid | NY | |
| P01354282 | Other | WY | PALMETTO GBA MRR |
| 127072900 | Medicaid | WY | |
| W26174 | Other | WY | NORIDIAN MEDICARE SJMC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M-10577 | ID | MD | Surgery Physician |
| 147502 | NY | MD | Surgery Physician |
| 8000A | WY | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139788800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1420243200000",
"number": "1659345221",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 428",
"city": "JACKSON",
"state": "WY",
"postal_code": "830010428",
"telephone_number": "307-739-7690",
"fax_number": "307-739-7644"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "555 E BROADWAY AVE",
"address_2": "SUITE #229",
"city": "JACKSON",
"state": "WY",
"postal_code": "830018640",
"telephone_number": "307-739-7690",
"fax_number": "307-739-7644"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSENBERG",
"first_name": "MICHAEL",
"middle_name": "WARD",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-13",
"last_updated": "2015-01-03",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "WY",
"license": "8000A",
"primary": true
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "ID",
"license": "M-10577",
"primary": false
},
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "NY",
"license": "147502",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00953517",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PALMETTO GBA MRR",
"identifier": "P01354282",
"state": "WY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "127072900",
"state": "WY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NORIDIAN MEDICARE SJMC",
"identifier": "W26174",
"state": "WY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jackson, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.