Active NPI
Take George Pullos, M.D.
- Surgery Physician
- Cheyenne, WY
National Provider Identifier
1831284900
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- A73020
- Practice address
- 5201 Yellowstone Rd
Cheyenne, WY 82009-4741 - Phone
- (307) 632-1114
- Fax
- (307) 632-9920
- NPI assigned
- Oct 4, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | A73020 | WY | Primary |
Addresses
Primary practice location
5201 Yellowstone Rd
Cheyenne, WY 82009-4741
Mailing address
PO Box 20970
Cheyenne, WY 82003-7020
Phone (307) 632-1114
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100097800 | Medicaid | WY | |
| 1831284900 | Medicaid | WY |
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | tpullos4319@direct.crmcwy.org | Health Information Exchange (HIE) | Memorial Hospital of Laramie County |
| Direct Messaging Address | tpullos4319@direct.crmcwy.org | Direct | Memorial Hospital of Laramie County |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A73020 | WY | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cheyenne Surgical Center LLC | Current | Accepting new patients |
Interoperability endpoints
- tpullos4319@direct.crmcwy.org
Organizations & group practices 1
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.
-
- Ambulatory Surgical Clinic/Center
- Cheyenne, WY
- NPI 1730191651
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1666915200000",
"number": "1831284900",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 20970",
"city": "CHEYENNE",
"state": "WY",
"postal_code": "820037020",
"telephone_number": "307-632-1114",
"fax_number": "307-632-9920"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5201 YELLOWSTONE RD",
"city": "CHEYENNE",
"state": "WY",
"postal_code": "820094741",
"telephone_number": "307-632-1114",
"fax_number": "307-632-9920"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PULLOS",
"first_name": "TAKE",
"middle_name": "GEORGE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-04",
"last_updated": "2022-10-28",
"certification_date": "2022-10-28",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "WY",
"license": "A73020",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100097800",
"state": "WY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1831284900",
"state": "WY"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "tpullos4319@direct.crmcwy.org",
"affiliation": "Y",
"endpointDescription": "CRMC Direct Address",
"affiliationName": "Memorial Hospital of Laramie County",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "214 E 23rd St",
"city": "Cheyenne",
"state": "WY",
"country_code": "US",
"postal_code": "820013748",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "tpullos4319@direct.crmcwy.org",
"affiliation": "Y",
"endpointDescription": "CRMC Direct Address",
"affiliationName": "Memorial Hospital of Laramie County",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "214 E 23rd St",
"city": "Cheyenne",
"state": "WY",
"country_code": "US",
"postal_code": "820013748",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Cheyenne, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.