Clancy Clyde Brown, DPT, CSCS
Individual provider Active NPI Physical Therapist · Thayne, WY
NPI 1710271630 · NPPES record last updated Dec 12, 2012
Key facts
- NPI
- 1710271630
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 1366 (WY)
- Practice address
- 124 Petersen Pkwy Ste 1
Thayne, WY 83127-9754 - Phone
- (307) 883-7878
- Fax
- (307) 883-7877
- NPI assigned
- Jun 8, 2011
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
Merit-based Incentive Payment System (MIPS)
- Final score
- 83.26 of 100
- Quality
- 86.58
- Improvement activities
- 40
- Cost
- 68.79
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1366 | WY | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Core Concept Solutions | Current | Accepting new patients | |
| North Lincoln County Hospital District | Past | Accepting new patients | |
| North Lincoln County Hospital District | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1366 | WY | Yes |
Addresses
Primary practice location
124 Petersen Pkwy Ste 1
Thayne, WY 83127-9754
Mailing address
124 Petersen Pkwy Ste 1
Thayne, WY 83127-9754
Phone (307) 883-7878
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 121989800 | Medicaid | WY | |
| 103956300 | Medicaid | WY | |
| 117016300 | Medicaid | WY |
Other providers in Thayne, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 12, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.