Individual provider Active NPI

Julia Fairbank, P.A.

  • Physician Assistant
  • Lander, WY
National Provider Identifier
1861821837
Registry record updated Jul 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
585 Issued in WY
Practice address
745 Buena Vista Dr
Lander, WY 82520-3431
Phone
(307) 332-2941
Fax
(307) 332-1920
NPI assigned
Nov 10, 2013
Last updated
Jul 17, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 585 WY Primary
Physician Assistant 363A00000X 3738 CO

Addresses

Primary practice location

745 Buena Vista Dr
Lander, WY 82520-3431

Mailing address

745 Buena Vista Dr
Lander, WY 82520-3431
Phone (307) 332-2941

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140101000010 WY Practitioner - Physician Assistant 8325276041 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Lander Medical Clinic PCGroup PAC ID 1355323940, 18 clinicians

Practice addresses (Care Compare)

745 Buena Vista Dr
Lander, WY 82520-3431
Phone (307) 332-2941

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
3738COMDClinical Psychologist

Interoperability endpoints

  • Direct secure messaging: julia.fairbank.1@2483.direct.athenahealth.com
  • Direct secure messaging: julia.fairbank.1@29403.direct.athenahealth.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1384041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1437091200000",
    "number": "1861821837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "745 BUENA VISTA DR",
            "city": "LANDER",
            "state": "WY",
            "postal_code": "825203431",
            "telephone_number": "307-332-2941",
            "fax_number": "307-332-1920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "745 BUENA VISTA DR",
            "city": "LANDER",
            "state": "WY",
            "postal_code": "825203431",
            "telephone_number": "307-332-2941",
            "fax_number": "307-332-1920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAIRBANK",
        "first_name": "JULIA",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-11-10",
        "last_updated": "2015-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WY",
            "license": "585",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "3738",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lander, WY

Sources for this page

Verify at the official NPI Registry.