Individual provider Active NPI

Charlotte K Mason, FNP

  • Family Nurse Practitioner
  • Jackson, WY
National Provider Identifier
1710069273
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
17365.721 Issued in WY
Practice address
1110 Maple Way
Jackson, WY 83002
Phone
(307) 733-7003
NPI assigned
Oct 20, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 17365.721 WY Primary

Addresses

Primary practice location

1110 Maple Way
Jackson, WY 83002

Mailing address

PO Box 10738
Jackson, WY 83002
Phone (307) 733-7003

Other identifiers 1

IdentifierTypeStateIssuer
311661OtherWYBLUE CROSS BLUE SHIELD WY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY
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 1

Enrollment IDStateProvider typePAC IDDetails
I20110210001004 WY Practitioner - Nurse Practitioner 0648252585 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jackson Whole Family Health IncGroup PAC ID 0143202085, 2 clinicians

Practice addresses (Care Compare)

1110 Maple Way
Jackson, WY 83001-8567
Phone (307) 733-7003

Hospital & facility affiliations

  • St Johns Medical Center Hospital, Jackson, WY, CCN 530015

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
17365.721WYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Jackson Whole Family Health, Inc. Family CurrentSince Sep 1, 2002 Accepting new patients
P George Poore MD PC Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1710069273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10738",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "83002",
            "telephone_number": "307-733-7003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 MAPLE WAY",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "83002",
            "telephone_number": "307-733-7003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MASON",
        "first_name": "CHARLOTTE",
        "middle_name": "K",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WY",
            "license": "17365.721",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD WY",
            "identifier": "311661",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, WY

Sources for this page

Verify at the official NPI Registry.