Individual provider Active NPI

Tobin S Dennis, M.D.

  • Emergency Medicine Physician
  • Jackson, WY
National Provider Identifier
1891141032
Registry record updated Jan 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
12045A Issued in WY
Practice address
625 East Broadway Ave
Jackson, WY 83001-8642
Phone
(307) 739-7250
Fax
(307) 739-7249
NPI assigned
May 6, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X 12045A WY
Emergency Medicine Physician 207P00000X 12045A WY Primary

Addresses

Primary practice location

625 East Broadway Ave
Jackson, WY 83001-8642

Mailing address

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

Other practice location 1

2100 W Sunset Dr
Riverton, WY 82501-2274
Phone (307) 856-4161

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tdennis@sjmc.cernerdirect.com Direct

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190731002205 WY Practitioner - Emergency Medicine 9234424110 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Washington School of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Teton County Hospital DistrictGroup PAC ID 4880582295, 107 clinicians

Practice addresses (Care Compare)

625 E Broadway Ave
Jackson, WY 83001-8642
Phone (307) 733-3636

Hospital & facility affiliations

  • St Johns Medical Center Hospital, Jackson, WY, CCN 530015

Merit-based Incentive Payment System (MIPS)

Final score
81.82 of 100Reported as group
Quality
67.1
Promoting interoperability
98
Improvement activities
40
Cost
73.98

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
12045AWYMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Teton County Hospital District CurrentSince Jul 1, 2019 Accepting new patients
Northwest Emergency Physicians LLC Emergency Medicine CurrentSince Jul 15, 2019 Accepting new patients
Teton County Hospital District Emergency Medicine CurrentSince Jul 1, 2019 Accepting new patients
Grand Health LLC Current Accepting new patients

Locations

2100 W Sunset Dr
Riverton, WY 82501
Phone (307) 856-4161

Organizations & group practices 4

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.

Hospital & facility affiliations 1

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": "1462492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611360000000",
    "number": "1891141032",
    "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 EAST BROADWAY AVE",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830018642",
            "telephone_number": "307-739-7250",
            "fax_number": "307-739-7249"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2100 W Sunset Dr",
            "address_purpose": "LOCATION",
            "city": "Riverton",
            "state": "WY",
            "postal_code": "825012274",
            "country_code": "US",
            "telephone_number": "307-856-4161",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DENNIS",
        "first_name": "TOBIN",
        "middle_name": "S",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-06",
        "last_updated": "2021-01-23",
        "certification_date": "2021-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "WY",
            "license": "12045A",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WY",
            "license": "12045A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tdennis@sjmc.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "Direct Messaging Address for St John's Health",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Other",
            "address_1": "625 East Broadway Ave",
            "city": "Jackson",
            "state": "WY",
            "country_code": "US",
            "postal_code": "830018642",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Jackson, WY

Sources for this page

Verify at the official NPI Registry.