NPIMap

Organization Active NPI

Johnson County Memorial Hospital

Doing business as Susie Bowling Lawrence Hospice

  • Community Based Hospice Care Agency
  • Buffalo, WY
National Provider Identifier
1891774873
Registry record updated Aug 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
06079 Issued in WY
Legal business name
JOHNSON COUNTY MEMORIAL HOSPITAL
Doing business as
Susie Bowling Lawrence Hospice
Practice address
497 West Lott
Buffalo, WY 82834-1609
Phone
(307) 684-5521
Fax
(307) 684-5385
NPI assigned
Jan 10, 2006
Last updated
Aug 12, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2024

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

Authorized official

Name
Mr. Luke Senden
Title
Ceo
Phone
(307) 684-6188

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 06079 WY Primary

Addresses

Primary practice location

497 West Lott
Buffalo, WY 82834-1609

Mailing address

497 West Lott
Buffalo, WY 82834-1609
Phone (307) 684-5521

Other identifiers 2

IdentifierTypeStateIssuer
105651108MedicaidWY
106561107MedicaidWY

Other names 1

  • Susie Bowling Lawrence Hospice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120510000515 WY Part A Provider - Hospice 5193610947 Practice locations: Buffalo, WY

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1891774873. Details of each certification follow.

Hospice certification: CCN 531506

Legal name
JOHNSON COUNTY MEMORIAL HOSPITAL
Doing business as
SUSIE BOWLING LAWRENCE HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Aug 26, 1994
Last certification
Sep 30, 2021
Ownership / control type
Combination Government and Nonprofit
Organization structure
GovernmentNon-profit
Enrollment address
497 W Lott St
Buffalo, WY 82834-1658

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Susie Bowling Lawrence HospiceCCN 531506 · All quality measures
Ownership
Government
Certified
Aug 26, 1994
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Johnson County Memorial Hospital3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Cristella Kinghorn Individual Corporate DirectorBoard Member Nov 30, 2016
Thomas Berry Individual Corporate DirectorBoard Member Nov 1, 1992
Alecia Kozisek Individual Corporate DirectorBoard Member Nov 30, 2018
Laurie Hansen Individual OtherDirector of Administration Sep 1, 2012
Luke Senden Individual W-2 Managing EmployeeCeo Jul 5, 2021
Operational/Managerial ControlCeo Jul 5, 2021
Tom Holt Individual Corporate DirectorBoard Member Nov 30, 2018
Johnson County Memorial Hospital Organization, Buffalo, WY 5% Or Greater Direct Ownership Interest Jul 1, 1995 100%
Mark S Schueler Individual Corporate DirectorBoard Member Nov 30, 2016
Johnson County Hospital District Organization, Buffalo, WY Created for acquisition 5% Or Greater Direct Ownership Interest Jan 15, 1992 100%

Owners & managing parties with NPI records 3

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
Johnson County Healthcare Center Home Health AgencyBuffalo, WY, CCN 537026 Home health agency Operational/Managerial Control May 30, 1984

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 2

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

Practitioners & affiliated clinicians

Affiliated clinicians 5

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

NPI Registry JSON

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

{
    "created_epoch": "1136851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723420800000",
    "number": "1891774873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "497 WEST LOTT",
            "city": "BUFFALO",
            "state": "WY",
            "postal_code": "828341609",
            "telephone_number": "307-684-5521",
            "fax_number": "307-684-5385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "497 WEST LOTT",
            "city": "BUFFALO",
            "state": "WY",
            "postal_code": "828341609",
            "telephone_number": "307-684-5521",
            "fax_number": "307-684-5385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHNSON COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-10",
        "last_updated": "2024-08-12",
        "certification_date": "2024-08-12",
        "status": "A",
        "authorized_official_last_name": "SENDEN",
        "authorized_official_first_name": "LUKE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "307-684-6188",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "WY",
            "license": "06079",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "105651108",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "106561107",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Susie Bowling Lawrence Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Buffalo, WY

Sources for this page

Verify at the official NPI Registry.