NPIMap

Organization Active NPI

Cheyenne MRI LLC

  • Radiology Clinic/Center
  • Cheyenne, WY
National Provider Identifier
1689613572
Registry record updated Jun 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
Legal business name
CHEYENNE MRI LLC
Practice address
2003 Bluegrass Cir
Cheyenne, WY 82009-7329
Phone
(307) 634-7711
Fax
(307) 634-4167
NPI assigned
Jun 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2020

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

Authorized official

Name
David Haid
Title
Administrator
Phone
(307) 634-7711

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X WY Primary

Addresses

Primary practice location

2003 Bluegrass Cir
Cheyenne, WY 82009-7329

Mailing address

2003 Bluegrass Cir
Cheyenne, WY 82009-7329
Phone (307) 634-7711

Other identifiers 2

IdentifierTypeStateIssuer
94005212MedicaidCO
106217401MedicaidWY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040319000673 WY Part B Supplier - Clinic/Group Practice 6507756798 Receives reassigned benefits from 9 practitioners
Practice locations: Cheyenne, WY

National Provider Directory

National Provider Directory

Locations

800 E 20th St
#10
Cheyenne, WY 82001

2003 Bluegrass Cir
Cheyenne, WY 82009
Phone (307) 432-3924

Practitioners & affiliated clinicians

Practitioners 12

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": "1149552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591056000000",
    "number": "1689613572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2003 BLUEGRASS CIR",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820097329",
            "telephone_number": "307-634-7711",
            "fax_number": "307-634-4167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2003 BLUEGRASS CIR",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820097329",
            "telephone_number": "307-634-7711",
            "fax_number": "307-634-4167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHEYENNE MRI LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-06",
        "last_updated": "2020-06-02",
        "certification_date": "2020-06-02",
        "status": "A",
        "authorized_official_last_name": "HAID",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "307-634-7711"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "WY",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "94005212",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "106217401",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cheyenne, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 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.