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Organization Active NPI

Crook County Medical Services District

  • Critical Access Hospital
  • Sundance, WY
National Provider Identifier
1871660159
Registry record updated Sep 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
07-127 Issued in WY
Legal business name
CROOK COUNTY MEDICAL SERVICES DISTRICT
Practice address
713 Oak Street
Sundance, WY 82729-0517
Phone
(307) 283-3501
Fax
(307) 283-2255
NPI assigned
Nov 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2022

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

Authorized official

Name
Micki Dahne Lyons, DNPNPI 1023445459
Title
Ceo
Phone
(307) 283-3501

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 07-127 WY Primary
Nursing Facility/Intermediate Care Facility 313M00000X
Skilled Nursing Facility 314000000X
Inpatient Hospice 315D00000X
Land Ambulance 3416L0300X

Addresses

Primary practice location

713 Oak Street
Sundance, WY 82729-0517

Mailing address

713 Oak Street
PO Box 517
Sundance, WY 82729-0517
Phone (307) 283-3501

Other identifiers 5

IdentifierTypeStateIssuer
106168200MedicaidWY
106168202MedicaidWY
106168211MedicaidWY
106168203MedicaidWY
106168204MedicaidWY

Other names 1

  • Crook County Memorial Hospital Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040127001018 WY Part B Supplier - Clinic/Group Practice 9234032483 Receives reassigned benefits from 13 practitioners
4 other NPIs on this enrollment
Practice locations: Hulett, WY; Moorcroft, WY; Sundance, WY
O20091023000380 WY Part A Provider - Critical Access Hospital 9234032483 Receives reassigned benefits from 10 practitioners
Practice locations: Sundance, WY
O20091023000391 WY Part A Provider - Critical Access Hospital 9234032483 Practice locations: Sundance, WY

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Hospital certification: CCN 531311

Legal name
CROOK COUNTY MEDICAL SERVICES DISTRICT
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Feb 1, 2004
Last certification
Apr 28, 2022
Beds
16
Ownership / control type
Hospital district or authority
Organization structure
OtherProprietary
Enrollment address
713 E Oak St
Sundance, WY 82729-5172

Hospital certification: CCN 53Z311

Legal name
CROOK COUNTY MEDICAL SERVICES DISTRICT
Organization structure
GovernmentProprietary
Enrollment address
713 E Oak St
Sundance, WY 82729-5172
Other Hospital Practice Location

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Donna Marlene Edwards Individual Corporate Officer Oct 1, 2010
Corporate OfficerBoard Member Nov 1, 2024
Micki D Lyons Individual Operational/Managerial ControlCeo Apr 1, 2020
William Brent Fowler Individual Corporate Officer Nov 1, 2022
Julie Sanderson-Zaato Individual W-2 Managing EmployeeBusiness Office Manager Aug 28, 2022
Robert N Hibbard Individual Corporate Officer Nov 1, 2024
Crook County Medical Services District Organization, Sundance, WY Operational/Managerial Control May 14, 1999
Operational/Managerial Control Nov 23, 2015
Sharon Coleman Individual Corporate Officer Nov 1, 2024
Corporate OfficerBoard Member Nov 1, 2024
Sandra Neiman Individual Corporate Director Oct 1, 2010

Owners & managing parties with NPI records 5

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Sundance ClinicSundance, WY, CCN 533976 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 26, 1995

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Other NPIs on the same Medicare enrollment 4

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

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

Affiliated clinicians 21

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

View all 21

Care Compare: Hospital

Medicare Care Compare
Listed as
Crook County HospitalCCN 531311
Type
Critical Access Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

NPI Registry JSON

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663632000000",
    "number": "1871660159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "713 OAK STREET",
            "address_2": "PO BOX 517",
            "city": "SUNDANCE",
            "state": "WY",
            "postal_code": "827290517",
            "telephone_number": "307-283-3501",
            "fax_number": "307-283-2255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "713 OAK STREET",
            "city": "SUNDANCE",
            "state": "WY",
            "postal_code": "827290517",
            "telephone_number": "307-283-3501",
            "fax_number": "307-283-2255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROOK COUNTY MEDICAL SERVICES DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-29",
        "last_updated": "2022-09-20",
        "certification_date": "2022-09-20",
        "status": "A",
        "authorized_official_last_name": "LYONS",
        "authorized_official_first_name": "MICKI",
        "authorized_official_middle_name": "DAHNE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "307-283-3501",
        "authorized_official_credential": "DNP"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "WY",
            "license": "07-127",
            "primary": true
        },
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "315D00000X",
            "taxonomy_group": "",
            "desc": "Hospice, Inpatient",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "106168200",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "106168202",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "106168211",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "106168203",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "106168204",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crook County Memorial Hospital",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Crook County Memorial Hospital",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Sundance, WY

Sources for this page

Verify at the official NPI Registry.