Active NPI
Jed Cabrera, PA
- Physician Assistant
- Cheyenne, WY
National Provider Identifier
1962500611
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 375
- Practice address
- 820 East 17TH Street
Cheyenne, WY 82001-4797 - Phone
- (307) 632-2434
- Fax
- (307) 634-9295
- NPI assigned
- Sep 20, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 375 | WY | Primary |
Addresses
Primary practice location
820 East 17TH Street
Cheyenne, WY 82001-4797
Mailing address
820 East 17TH Street
Cheyenne, WY 82001-4797
Phone (307) 777-7911
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 24512 | Other | WY | WINHEALTH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 375 | WY | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| University of Wyoming | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Federally Qualified Health Center (FQHC)
- Laramie, WY
- NPI 1639617061
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158710400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1962500611",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "820 EAST 17TH STREET",
"city": "CHEYENNE",
"state": "WY",
"postal_code": "820014797",
"telephone_number": "307-777-7911",
"fax_number": "307-638-3616"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "820 EAST 17TH STREET",
"city": "CHEYENNE",
"state": "WY",
"postal_code": "820014797",
"telephone_number": "307-632-2434",
"fax_number": "307-634-9295"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CABRERA",
"first_name": "JED",
"name_prefix": "Mr.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-20",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WY",
"license": "375",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WINHEALTH",
"identifier": "24512",
"state": "WY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cheyenne, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.