NPIMap

Organization Active NPI

Lander Medical Clinic, PC

  • Family Medicine Physician
  • Lander, WY
National Provider Identifier
1932299690
Registry record updated Apr 3, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
LANDER MEDICAL CLINIC, PC
Practice address
745 Buena Vista
Lander, WY 82520-3431
Phone
(307) 332-2941
Fax
(307) 332-1920
NPI assigned
Oct 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2015

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

Authorized official

Name
Ryan L Hedges
Title
Ceo
Phone
(307) 332-2941

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X WY Primary
Durable Medical Equipment & Medical Supplies 332B00000X 0823410001 WY
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

745 Buena Vista
Lander, WY 82520-3431

Mailing address

PO Box 9432
Belfast, ME 04915-9432
Phone (307) 332-2941

Other identifiers 4

IdentifierTypeStateIssuer
00975001OtherWYBLUE SHIELD OF WYOMING
0823410001OtherWYMEDICARE DMEPOS
106224700MedicaidWY
CT0209OtherWYMEDICARE RAILROAD RETIREM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY, GA, NM, PA, AZ5 enrollments

Enrollment records 5

Enrollment IDStateProvider typePAC IDDetails
O20040607000680 WY Part B Supplier - Clinic/Group Practice 1355323940 Receives reassigned benefits from 18 practitioners
Practice locations: Lander, WY; Riverton, WY
O20220512001379 GA Part B Supplier - Clinic/Group Practice 1355323940 Receives reassigned benefits from 1 practitioner
Practice locations: Sandy Springs, GA
O20220525000662 NM Part B Supplier - Clinic/Group Practice 1355323940 Receives reassigned benefits from 1 practitioner
Practice locations: Albuquerque, NM
O20220526000750 PA Part B Supplier - Clinic/Group Practice 1355323940 Receives reassigned benefits from 2 practitioners
Practice locations: Penn Valley, PA
O20220613001856 AZ Part B Supplier - Clinic/Group Practice 1355323940 Receives reassigned benefits from 1 practitioner
Practice locations: Scottsdale, AZ

National Provider Directory

National Provider Directory

Locations

609 E Madison Ave
Riverton, WY 82501
Phone (307) 330-8183

219 S 2nd St W
Riverton, WY 82501
Phone (307) 856-6591

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/2483/brand/1/csg/1/fhir/r4

Practitioners & affiliated clinicians

Practitioners 26

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

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1428019200000",
    "number": "1932299690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9432",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049159432",
            "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",
            "city": "LANDER",
            "state": "WY",
            "postal_code": "825203431",
            "telephone_number": "307-332-2941",
            "fax_number": "307-332-1920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LANDER MEDICAL CLINIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-13",
        "last_updated": "2015-04-03",
        "status": "A",
        "authorized_official_last_name": "HEDGES",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "307-332-2941"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "WY",
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "WY",
            "license": "0823410001",
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF WYOMING",
            "identifier": "00975001",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE DMEPOS",
            "identifier": "0823410001",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "106224700",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD RETIREM",
            "identifier": "CT0209",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lander, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.