NPIMap

Organization Active NPI

Teton County Hospital District

Doing business as St Johns Medical Center ER Physicians

  • Emergency Medicine Physician
  • Jackson Hole, WY
National Provider Identifier
1821317595
Registry record updated Mar 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
15109 Issued in WY
Legal business name
TETON COUNTY HOSPITAL DISTRICT
Doing business as
St Johns Medical Center ER Physicians
Practice address
625 E Broadway Ave
Jackson Hole, WY 83001-8642
Phone
(307) 739-7250
Fax
(307) 739-7249
NPI assigned
May 20, 2010
Last updated
Mar 16, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
TETON COUNTY HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 16, 2016

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

Authorized official

Name
John J. Kren
Title
Cfo
Phone
(307) 739-7526

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 15109 WY Primary

Addresses

Primary practice location

625 E Broadway Ave
Jackson Hole, WY 83001-8642

Mailing address

PO Box 428
Jackson, WY 83001-0428
Phone (307) 739-7250

Other identifiers 1

IdentifierTypeStateIssuer
106299910MedicaidWY

Other names 1

  • St Johns Medical Center ER Physicians Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040308000954 WY Part B Supplier - Clinic/Group Practice 4880582295 Receives reassigned benefits from 131 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Wilson, WY; Teton Village, WY; Pinedale, WY; Jackson, WY; Afton, WY

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Part of
Teton County Hospital District

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1274313600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458086400000",
    "number": "1821317595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 428",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830010428",
            "telephone_number": "307-739-7250",
            "fax_number": "307-739-7249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 E BROADWAY AVE",
            "city": "JACKSON HOLE",
            "state": "WY",
            "postal_code": "830018642",
            "telephone_number": "307-739-7250",
            "fax_number": "307-739-7249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TETON COUNTY HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TETON COUNTY HOSPITAL DISTRICT",
        "enumeration_date": "2010-05-20",
        "last_updated": "2016-03-16",
        "status": "A",
        "authorized_official_last_name": "KREN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "307-739-7526"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WY",
            "license": "15109",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "106299910",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Johns Medical Center ER Physicians",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson Hole, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2016; 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.