NPIMap

Organization Active NPI

Campbell County Hospital District

Doing business as Powder River Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Gillette, WY
National Provider Identifier
1780738153
Registry record updated Mar 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
15210 Issued in WY
Legal business name
CAMPBELL COUNTY HOSPITAL DISTRICT
Doing business as
Powder River Surgery Center
Practice address
501 S Burma Ave
Gillette, WY 82716-3426
Phone
(307) 688-8600
NPI assigned
Jan 23, 2007
Last updated
Mar 6, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
CAMPBELL COUNTY MEMORIAL HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 6, 2017

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

Authorized official

Name
Michelle Kioschos, RN
Title
Director
Phone
(307) 688-8600

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 15210 WY Primary
General Acute Care Hospital 282N00000X 15210 WY

Addresses

Primary practice location

501 S Burma Ave
Gillette, WY 82716-3426

Mailing address

906 W 6TH St
Suite C
Gillette, WY 82716-3435
Phone (307) 688-8600

Other names 1

  • Powder River Surgery Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070926000248 WY Part A Provider - Hospital 2860392529 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Gillette, WY; Hulett, WY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1780738153. Details of each certification follow.

Hospital certification: CCN 530002

Legal name
CAMPBELL COUNTY HOSPITAL DISTRICT
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Mar 29, 2018
Beds
119
Ownership / control type
Hospital district or authority
Organization structure
CorporationNon-profit
Incorporated
Sep 19, 1974 in WY
Enrollment address
501 S Burma Ave
Gillette, WY 82716-3426
Other Hospital Practice Location
Hospital subgroups
Acute care

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Campbell County HealthCCN 530002 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Part of
Wyoming Regional Counseling

Ownership & related parties

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Gerard Klein Individual Corporate OfficerCoo Sep 9, 2020
W-2 Managing Employee Sep 9, 2020

Practitioners & affiliated clinicians

Affiliated clinicians 312

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 312

NPI Registry JSON

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488758400000",
    "number": "1780738153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "906 W 6TH ST",
            "address_2": "SUITE C",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827163435",
            "telephone_number": "307-688-8600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 S BURMA AVE",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827163426",
            "telephone_number": "307-688-8600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMPBELL COUNTY HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CAMPBELL COUNTY MEMORIAL HEALTH",
        "enumeration_date": "2007-01-23",
        "last_updated": "2017-03-06",
        "status": "A",
        "authorized_official_last_name": "KIOSCHOS",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "307-688-8600",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "WY",
            "license": "15210",
            "primary": true
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "WY",
            "license": "15210",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Powder River Surgery Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gillette, WY

Sources for this page

Verify at the official NPI Registry.