NPIMap

Individual provider Active NPI

Wade Travis Bomengen, M.D.

  • Family Medicine Physician
  • Thermopolis, WY
National Provider Identifier
1710959168
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5946AWY Issued in WY
Practice address
120 N C Ave
Thermopolis, WY 82443-2410
Phone
(307) 864-5534
Fax
(307) 864-9470
NPI assigned
Feb 1, 2006
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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 5946AWY WY Primary

Addresses

Primary practice location

120 N C Ave
Thermopolis, WY 82443-2410

Mailing address

120 N C Ave
Thermopolis, WY 82443-2410
Phone (307) 864-5534

Other identifiers 3

IdentifierTypeStateIssuer
113009900MedicaidWY
5946AWYOtherWYWY MEDICAL LICENSE #
613WB97OtherWYWY CONTROLLED SUBSTANCE #

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101012000734 WY Practitioner - Family Practice 9234113176 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Baylor College of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
William H and Carrie Gottsche FoundationGroup PAC ID 5092606293, 73 clinicians

Practice addresses (Care Compare)

148 E Arapahoe St
Thermopolis, WY 82443-2402
Phone (307) 864-2146

150 E Arapahoe St
Thermopolis, WY 82443-2402
Phone (307) 864-5061

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5946AWYWYMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Wyoming Speech and Hearing Clinic CurrentSince Mar 1, 2019 Accepting new patients
University of Wyoming Family Medicine CurrentSince Mar 1, 2019 Accepting new patients
University of Wyoming Family Medicine Current Accepting new patients
Hot Springs County Hospital District CurrentSince Jul 6, 2016 Accepting new patients
Hot Springs County Hospital District CurrentSince Jul 6, 2016 Accepting new patients
Hot Springs County Hospital District Family Medicine Past Accepting new patients
University of Wyoming Family Medicine Past Accepting new patients

Locations

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

820 E 17th St
Cheyenne, WY 82001
Phone (307) 431-5055

2002 W Sunset Dr
Ste 2
Riverton, WY 82501
Phone (307) 857-7300

120 N C Ave
Thermopolis, WY 82443
Phone (307) 864-5534

150 E Arapahoe St
Thermopolis, WY 82443
Phone (307) 864-3121

1125 Charles Ave
Worland, WY 82401
Phone (307) 347-2449

Interoperability endpoints

  • Direct secure messaging: tbomengen@hscmh.cernerdirect.com

Organizations & group practices 10

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.

Hospital & facility affiliations 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1138752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1710959168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 N C AVE",
            "city": "THERMOPOLIS",
            "state": "WY",
            "postal_code": "824432410",
            "telephone_number": "307-864-5534",
            "fax_number": "307-864-9470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 N C AVE",
            "city": "THERMOPOLIS",
            "state": "WY",
            "postal_code": "824432410",
            "telephone_number": "307-864-5534",
            "fax_number": "307-864-9470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOMENGEN",
        "first_name": "WADE",
        "middle_name": "TRAVIS",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-01",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WY",
            "license": "5946AWY",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "113009900",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WY MEDICAL LICENSE #",
            "identifier": "5946AWY",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WY CONTROLLED SUBSTANCE #",
            "identifier": "613WB97",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Thermopolis, WY

Sources for this page

Verify at the official NPI Registry.