Individual provider Active NPI

Douglas Tew, PA-C

  • Physician Assistant
  • Gillette, WY
National Provider Identifier
1902153323
Registry record updated Apr 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
547 Issued in WY
Practice address
430 S Medical Arts CT
Gillette, WY 82716-3364
Phone
(307) 685-6500
Fax
(307) 685-3081
NPI assigned
Aug 6, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 547 WY Primary

Addresses

Primary practice location

430 S Medical Arts CT
Gillette, WY 82716-3364

Mailing address

430 S Medical Arts CT
Gillette, WY 82716-3364
Phone (307) 685-6500

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
I20150915003135 WY Practitioner - Physician Assistant 1658688106 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Campbell County Hospital DistrictGroup PAC ID 2860392529, 128 clinicians

Practice addresses (Care Compare)

501 S Burma Ave
Gillette, WY 82716-3426
Phone (307) 688-1000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
547WYMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Campbell County Hospital District Current Accepting new patients
Campbell County Hospital District CurrentSince Aug 1, 2015 Accepting new patients
Campbell County Hospital District CurrentSince Aug 1, 2015 Accepting new patients
Campbell County Hospital District Past Accepting new patients

Locations

430 S Medical Arts Ct
Gillette, WY 82716
Phone (307) 685-6500

501 S Burma Ave
Fl 3
Gillette, WY 82716
Phone (307) 688-3636

501 S Burma Ave
Gillette, WY 82716
Phone (307) 682-8811

Organizations & group practices 5

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 2

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": "1344211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619568000000",
    "number": "1902153323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 S MEDICAL ARTS CT",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827163364",
            "telephone_number": "307-685-6500",
            "fax_number": "307-685-3081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 S MEDICAL ARTS CT",
            "city": "GILLETTE",
            "state": "WY",
            "postal_code": "827163364",
            "telephone_number": "307-685-6500",
            "fax_number": "307-685-3081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEW",
        "first_name": "DOUGLAS",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-08-06",
        "last_updated": "2021-04-28",
        "certification_date": "2021-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WY",
            "license": "547",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gillette, WY

Sources for this page

Verify at the official NPI Registry.