Active NPI
Draper Dermatology, P.C.
- Dermatology Physician
- Evanston, WY
National Provider Identifier
1942832159
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- Legal business name
- DRAPER DERMATOLOGY, P.C.
- Practice address
- 196 Arrowhead Dr Ste 7
Evanston, WY 82930-8752 - Phone
- (801) 232-6556
- Fax
- (801) 987-8467
- NPI assigned
- Feb 5, 2020
- Last updated
- Nov 27, 2023
- Organization subpart
- Yes
- Parent organization
- DRAPER DERMATOLOGY
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ryan Cooksey
- Title
- Practice Administrator
- Phone
- (801) 232-6556
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | Primary |
Addresses
Primary practice location
196 Arrowhead Dr Ste 7
Evanston, WY 82930-8752
Mailing address
1325 W South Jordan Pkwy Ste 103
South Jordan, UT 84095-9060
Phone (801) 232-6556
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 154374100 | Medicaid | WY |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | larryderm@draperderm.emadirect.md | Health Information Exchange (HIE) |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200415002290 | WY | Part B Supplier - Clinic/Group Practice | 4688928526 |
Receives reassigned benefits from 6 practitioners Practice locations: Evanston, WY |
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
National Provider Directory
National Provider Directory- Part of
- Draper Dermatology PC
Practitioners & affiliated clinicians
Practitioners 6
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Physician Assistant
- Kemmerer, WY
- NPI 1619592953
-
- MOHS-Micrographic Surgery Physician
- Providence, UT
- NPI 1598086720
Dermatology, WY
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1580860800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1701043200000",
"number": "1942832159",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1325 W SOUTH JORDAN PKWY STE 103",
"city": "SOUTH JORDAN",
"state": "UT",
"postal_code": "840959060",
"telephone_number": "801-232-6556",
"fax_number": "801-987-8467"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "196 ARROWHEAD DR STE 7",
"city": "EVANSTON",
"state": "WY",
"postal_code": "829308752",
"telephone_number": "801-232-6556",
"fax_number": "801-987-8467"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DRAPER DERMATOLOGY, P.C.",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "DRAPER DERMATOLOGY",
"enumeration_date": "2020-02-05",
"last_updated": "2023-11-27",
"certification_date": "2020-03-05",
"status": "A",
"authorized_official_last_name": "COOKSEY",
"authorized_official_first_name": "RYAN",
"authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
"authorized_official_telephone_number": "801-232-6556"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "154374100",
"state": "WY"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "larryderm@draperderm.emadirect.md",
"affiliation": "Y",
"endpointDescription": "Direct Mail for Dr. Urry",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "Text",
"address_1": "1325 W South Jordan Pkwy Ste 103",
"city": "South Jordan",
"state": "UT",
"country_code": "US",
"postal_code": "840959060",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Evanston, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; 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.