Individual provider Active NPI

Tiffany Janae Spaulding, D.O.

  • Family Medicine Physician
  • Casper, WY
National Provider Identifier
1679704753
Registry record updated Aug 6, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
TL#1206 Issued in WY
Practice address
1522 E a St
Casper, WY 82601-2217
Phone
(307) 233-6000
Fax
(307) 265-0841
NPI assigned
Aug 6, 2009
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 6, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X TL#1206 WY Primary

Addresses

Primary practice location

1522 E a St
Casper, WY 82601-2217

Mailing address

1522 E a St
Casper, WY 82601-2217
Phone (307) 233-6000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110921000209 ID Practitioner - Family PracticePractitioner - Emergency Medicine 3274718036 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
TL#1206WYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Upper Valley Family Medicine PLLC Family Medicine CurrentSince Aug 1, 2012 Accepting new patients
Medical Imaging Associates of Idaho Falls, Inc Past Accepting new patients
Teton Valley Health Care Inc Past Accepting new patients

Locations

711 Rigby Lake Dr
Ste 1500
Rigby, ID 83442
Phone (208) 745-5021

711 Rigby Lake Dr
Ste 115
Rigby, ID 83442
Phone (208) 745-5021

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/CEAEDD/Endpoint/CEAEDD

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1249516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1249516800000",
    "number": "1679704753",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1522 E A ST",
            "city": "CASPER",
            "state": "WY",
            "postal_code": "826012217",
            "telephone_number": "307-233-6000",
            "fax_number": "307-265-0841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1522 E A ST",
            "city": "CASPER",
            "state": "WY",
            "postal_code": "826012217",
            "telephone_number": "307-233-6000",
            "fax_number": "307-265-0841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPAULDING",
        "first_name": "TIFFANY",
        "middle_name": "JANAE",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-08-06",
        "last_updated": "2009-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WY",
            "license": "TL#1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Casper, WY

Sources for this page

Verify at the official NPI Registry.