| St John's Health | |
|
625 E Broadway Ave Jackson WY 83001-8642 | |
| (307) 733-3636 | |
| (877) 205-2024 |
| Full Name | St John's Health |
|---|---|
| Speciality | General Practice |
| Location | 625 E Broadway Ave, Jackson, Wyoming |
| Authorized Official Name and Position | John Kren (COO/CFO) |
| Authorized Official Contact | 3077397526 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| St John's Health Po Box 428 Jackson WY 83001-0428 Ph: (307) 733-3636 | St John's Health 625 E Broadway Ave Jackson WY 83001-8642 Ph: (307) 733-3636 |
| NPI Number | 1487818605 |
|---|---|
| Provider Enumeration Date | 07/16/2008 |
| Last Update Date | 03/17/2022 |
| Medicare PECOS PAC ID | 4880582295 |
|---|---|
| Medicare Enrollment ID | O20040308000954 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487818605 | NPI | - | NPPES |
| 806430200 | Medicaid | ID | |
| 1062999-09 | Medicaid | WY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | 15109 (Wyoming) | Primary |
| 273Y00000X | Rehabilitation Unit | (* (Not Available)) | Secondary |
| Provider Name | Laura M Vignaroli |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1639249550 PECOS PAC ID: 6103810445 Enrollment ID: I20040412000246 |
| Provider Name | William R Smith |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1003922360 PECOS PAC ID: 5496727224 Enrollment ID: I20040811000697 |
| Provider Name | Lisa J Finkelstein |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1689787566 PECOS PAC ID: 4385612738 Enrollment ID: I20040922001201 |
| Provider Name | Marc Domsky |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1821103268 PECOS PAC ID: 5991745101 Enrollment ID: I20050506000590 |
| Provider Name | Albert Richard Wheeler |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1780797050 PECOS PAC ID: 9739114711 Enrollment ID: I20050928000859 |
| Provider Name | Kerry Brooke Carr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285716746 PECOS PAC ID: 8527049857 Enrollment ID: I20051105000328 |
| Provider Name | Karen E Worman |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1871560102 PECOS PAC ID: 5991777278 Enrollment ID: I20061207000152 |
| Provider Name | David J Tomlinson |
|---|---|
| Provider Type | Practitioner - Anesthesiology |
| Provider Identifiers | NPI Number: 1851350292 PECOS PAC ID: 7012945751 Enrollment ID: I20061218000163 |
| Provider Name | David P Kappenman |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134149958 PECOS PAC ID: 9335174788 Enrollment ID: I20070213000569 |
| Provider Name | Michael J Menolascino |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1447364245 PECOS PAC ID: 3476641549 Enrollment ID: I20071127000195 |
| Provider Name | Shawn B Wright |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1003857624 PECOS PAC ID: 7012907058 Enrollment ID: I20080211000173 |
| Provider Name | Richard W Carver |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1083785281 PECOS PAC ID: 8325127632 Enrollment ID: I20080512000113 |
| Provider Name | James R Little |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1336169036 PECOS PAC ID: 2466477971 Enrollment ID: I20080807000452 |
| Provider Name | Martin S Trott |
|---|---|
| Provider Type | Practitioner - Otolaryngology |
| Provider Identifiers | NPI Number: 1245339456 PECOS PAC ID: 7315923364 Enrollment ID: I20080915000053 |
| Provider Name | Jenaneta S Hampton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396817516 PECOS PAC ID: 2769546472 Enrollment ID: I20090126000049 |
| Provider Name | Michael Rosenberg |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1659345221 PECOS PAC ID: 6305900028 Enrollment ID: I20090126000052 |
| Provider Name | Jeffrey D Greenbaum |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1649383001 PECOS PAC ID: 5092909622 Enrollment ID: I20101028000012 |
| Provider Name | Sharon Eskam |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1629095310 PECOS PAC ID: 1153379367 Enrollment ID: I20101109000049 |
| Provider Name | John H Ward |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1831289420 PECOS PAC ID: 2769451616 Enrollment ID: I20101117001484 |
| Provider Name | Mark B Bromberg |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1164517009 PECOS PAC ID: 5890757421 Enrollment ID: I20101119000920 |
| Provider Name | Martha G Stearn |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1285748343 PECOS PAC ID: 9537356290 Enrollment ID: I20101207000432 |
| Provider Name | Roseanne R Prince |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1093996449 PECOS PAC ID: 2567634728 Enrollment ID: I20111012000119 |
| Provider Name | Christine H Turner |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1194914747 PECOS PAC ID: 2567541550 Enrollment ID: I20111026000123 |
| Provider Name | David R Renner |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1396835914 PECOS PAC ID: 6204897861 Enrollment ID: I20120216000248 |
| Provider Name | Layne E Lash |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851661284 PECOS PAC ID: 7719145747 Enrollment ID: I20120222000870 |
| Provider Name | Weston Marshall Swindlehurst |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1952628505 PECOS PAC ID: 0547449126 Enrollment ID: I20120615000327 |
| Provider Name | Marcia Lux |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1972531572 PECOS PAC ID: 5395714547 Enrollment ID: I20120803000646 |
| Provider Name | Daniel Anthony Nelson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1447488135 PECOS PAC ID: 2860637345 Enrollment ID: I20130404000319 |
| Provider Name | Kathryn M Noyes |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194969048 PECOS PAC ID: 8426294398 Enrollment ID: I20130419000126 |
| Provider Name | Cecelia A. Tramburg |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942648365 PECOS PAC ID: 8224270400 Enrollment ID: I20130821000239 |
| Provider Name | Leah N Gibson |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1376964544 PECOS PAC ID: 0244453801 Enrollment ID: I20140529000479 |
| Provider Name | Randy J. Kjorstad |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1043283336 PECOS PAC ID: 6002003639 Enrollment ID: I20140702002454 |
| Provider Name | Sarah K Mcdaniel |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1184863664 PECOS PAC ID: 9931266087 Enrollment ID: I20150123000452 |
| Provider Name | Jonathan P Boltax |
|---|---|
| Provider Type | Practitioner - Pulmonary Disease |
| Provider Identifiers | NPI Number: 1629023692 PECOS PAC ID: 3577504695 Enrollment ID: I20150324002473 |
| Provider Name | Christian A Dean |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437412806 PECOS PAC ID: 1153551080 Enrollment ID: I20150806012761 |
| Provider Name | Robert D Wood |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619228186 PECOS PAC ID: 7416108329 Enrollment ID: I20150921001948 |
| Provider Name | Mark Neimat |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1407143100 PECOS PAC ID: 4981823119 Enrollment ID: I20151109001443 |
| Provider Name | Barron Justin Reyes |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1891087300 PECOS PAC ID: 6608092549 Enrollment ID: I20151110002982 |
| Provider Name | Alicia Peterson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1215296561 PECOS PAC ID: 8426360447 Enrollment ID: I20151111000421 |
| Provider Name | Sarah Peterson |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1194196667 PECOS PAC ID: 4385944958 Enrollment ID: I20151203002262 |
| Provider Name | Tiffany L Milner |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1639323116 PECOS PAC ID: 5496905812 Enrollment ID: I20160621001117 |
| Provider Name | Holbrook H Stoecklein |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1780927541 PECOS PAC ID: 0547583007 Enrollment ID: I20160810002273 |
| Provider Name | Eric Andrew Wieman |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1902021553 PECOS PAC ID: 8628216272 Enrollment ID: I20161222000655 |
| Provider Name | Robert J Farney |
|---|---|
| Provider Type | Practitioner - Sleep Medicine |
| Provider Identifiers | NPI Number: 1841386513 PECOS PAC ID: 6103842570 Enrollment ID: I20170421000693 |
| Provider Name | William L Mullen |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1457362329 PECOS PAC ID: 0345234290 Enrollment ID: I20170426002436 |
| Provider Name | Krishna M Sundar |
|---|---|
| Provider Type | Practitioner - Sleep Medicine |
| Provider Identifiers | NPI Number: 1801802186 PECOS PAC ID: 6406757731 Enrollment ID: I20170524000847 |
| Provider Name | Erin Anne Clark |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1457305757 PECOS PAC ID: 9335147354 Enrollment ID: I20170728001557 |
| Provider Name | Kelly J Biscombe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861922122 PECOS PAC ID: 8224309786 Enrollment ID: I20170802002552 |
| Provider Name | Rebecca F Heisinger |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1730624990 PECOS PAC ID: 3375829104 Enrollment ID: I20170914001416 |
| Provider Name | Anna Otis Felton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538688015 PECOS PAC ID: 3476828765 Enrollment ID: I20171012002788 |
| Provider Name | Joseph W. Raboin |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1235547803 PECOS PAC ID: 8224351564 Enrollment ID: I20180522000662 |
| Provider Name | Lindsay Long |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1780011551 PECOS PAC ID: 4587929542 Enrollment ID: I20180523001351 |
| Provider Name | Ted Olin Morgan |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1639160245 PECOS PAC ID: 6305894429 Enrollment ID: I20180618003089 |
| Provider Name | Anna Bramley Catino |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1427282318 PECOS PAC ID: 2668691486 Enrollment ID: I20180725001185 |
| Provider Name | John Keith Hayes |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1275672933 PECOS PAC ID: 3072402254 Enrollment ID: I20180810003083 |
| Provider Name | Glenn Edward Burnett |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1467400747 PECOS PAC ID: 1456381680 Enrollment ID: I20180816001505 |
| Provider Name | Roger S Hansen |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1811036478 PECOS PAC ID: 9133106297 Enrollment ID: I20180824000696 |
| Provider Name | Lauren H Theilen |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1174802250 PECOS PAC ID: 6507095270 Enrollment ID: I20180904001655 |
| Provider Name | Brandon J Fisher |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1275789026 PECOS PAC ID: 3779731708 Enrollment ID: I20181022000111 |
| Provider Name | Kevin Sanville |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134307911 PECOS PAC ID: 4486602000 Enrollment ID: I20181026000322 |
| Provider Name | Haven R Malish |
|---|---|
| Provider Type | Practitioner - Sleep Medicine |
| Provider Identifiers | NPI Number: 1831283936 PECOS PAC ID: 5496848707 Enrollment ID: I20190402001281 |
| Provider Name | Michael Abram Tenofsky |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1194965608 PECOS PAC ID: 5890827596 Enrollment ID: I20190425000816 |
| Provider Name | Brittany Hayden Jones |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1164707907 PECOS PAC ID: 1557538519 Enrollment ID: I20190530000890 |
| Provider Name | Tobin Dennis |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1891141032 PECOS PAC ID: 9234424110 Enrollment ID: I20190731002205 |
| Provider Name | Lauren E Furtney |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093161572 PECOS PAC ID: 1759610157 Enrollment ID: I20190910003538 |
| Provider Name | Stephanie M Lyden |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1962883850 PECOS PAC ID: 3971894239 Enrollment ID: I20191025000620 |
| Provider Name | Kyle Mahoney |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1568707586 PECOS PAC ID: 2466685987 Enrollment ID: I20191030001949 |
| Provider Name | Stephanie Kay Ferris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770127136 PECOS PAC ID: 2961835772 Enrollment ID: I20191210000763 |
| Provider Name | Daniel H Miller |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1447694922 PECOS PAC ID: 6406097799 Enrollment ID: I20191227000250 |
| Provider Name | Elizabeth Smith Dannewald |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669949590 PECOS PAC ID: 1850726498 Enrollment ID: I20200108002767 |
| Provider Name | Paolo Moretti |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1093968265 PECOS PAC ID: 5395808000 Enrollment ID: I20200127001075 |
| Provider Name | Nathan Blue |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1427300938 PECOS PAC ID: 0244547438 Enrollment ID: I20200131001073 |
| Provider Name | Carrie Ross Quinlan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942711254 PECOS PAC ID: 2163788910 Enrollment ID: I20200325000834 |
| Provider Name | Michelle Brittany Robertson |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1154969251 PECOS PAC ID: 4486083516 Enrollment ID: I20200410001231 |
| Provider Name | Sharon L Bailey |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558454934 PECOS PAC ID: 0648394882 Enrollment ID: I20200529001916 |
| Provider Name | Nils Charles Westfall |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1992047682 PECOS PAC ID: 5193074888 Enrollment ID: I20200928003213 |
| Provider Name | Jeffrey Thomas Reisert |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1780668350 PECOS PAC ID: 4385634419 Enrollment ID: I20201012001568 |
| Provider Name | Chuanchau J Jou |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1104011998 PECOS PAC ID: 7214120260 Enrollment ID: I20201109002734 |
| Provider Name | Jason T Su |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1427137991 PECOS PAC ID: 0143291427 Enrollment ID: I20201116001557 |
| Provider Name | Thomas Jared Bunch |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1790757516 PECOS PAC ID: 3173601051 Enrollment ID: I20201207002587 |
| Provider Name | Allison Odato Armitage |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760074322 PECOS PAC ID: 4082021720 Enrollment ID: I20210325001587 |
| Provider Name | Russell Charles Miller |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1538408091 PECOS PAC ID: 7719127851 Enrollment ID: I20210611000575 |
| Provider Name | Alexandra E Flis |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1265723795 PECOS PAC ID: 9032339080 Enrollment ID: I20210712003606 |
| Provider Name | Kelly K Baxter |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1407351224 PECOS PAC ID: 4183970650 Enrollment ID: I20210715002903 |
| Provider Name | David Paul Steinberg |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1093705170 PECOS PAC ID: 9032178546 Enrollment ID: I20210802003615 |
| Provider Name | Brian K Turner |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1295876142 PECOS PAC ID: 0840253993 Enrollment ID: I20210809002648 |
| Provider Name | Benjamin Todd Jensen |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1376885988 PECOS PAC ID: 5597986893 Enrollment ID: I20211028001161 |
| Provider Name | Amanda J Miller |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1972842268 PECOS PAC ID: 0941441554 Enrollment ID: I20211110002284 |
| Provider Name | Michael M Green |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1063665719 PECOS PAC ID: 8022276500 Enrollment ID: I20211112001823 |
| Provider Name | Angela M Kent |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1861735730 PECOS PAC ID: 3173761426 Enrollment ID: I20211115002440 |
| Provider Name | Beyron Alexis Zecher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255917803 PECOS PAC ID: 1153719877 Enrollment ID: I20211207001604 |
| Provider Name | Kathleen A Vanier |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1790719011 PECOS PAC ID: 1850340092 Enrollment ID: I20220128000466 |
| Provider Name | Douglas E Holt |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1417310046 PECOS PAC ID: 3072914084 Enrollment ID: I20220328000776 |
| Provider Name | Pierre D Zabel |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1760717805 PECOS PAC ID: 6901045723 Enrollment ID: I20220401001045 |
| Provider Name | Paul Beisser |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1053346593 PECOS PAC ID: 0840327896 Enrollment ID: I20220721001765 |
| Provider Name | Charles William Franker |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1801327291 PECOS PAC ID: 0840563144 Enrollment ID: I20220808000722 |
| Provider Name | Ahmad Bashirimoghaddam |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1487144457 PECOS PAC ID: 2466835079 Enrollment ID: I20220815002368 |
| Provider Name | Michael Hackett |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1184688749 PECOS PAC ID: 8820980352 Enrollment ID: I20220817000930 |
| Provider Name | Kathleen Kerrigan |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1457779035 PECOS PAC ID: 9133446891 Enrollment ID: I20220919002026 |
| Provider Name | Laura-lee A Berrett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033840905 PECOS PAC ID: 1658747811 Enrollment ID: I20221013001865 |
| Provider Name | Guillaume Lamotte |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1114371416 PECOS PAC ID: 1557782687 Enrollment ID: I20221018000572 |
| Provider Name | James Osmanski |
|---|---|
| Provider Type | Practitioner - Sleep Medicine |
| Provider Identifiers | NPI Number: 1235275660 PECOS PAC ID: 3971519950 Enrollment ID: I20221104002126 |
| Provider Name | Ashley L Bostyan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639724099 PECOS PAC ID: 6002249042 Enrollment ID: I20221122001388 |
| Provider Name | Geoffrey Kuzmich |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1942257415 PECOS PAC ID: 9335108208 Enrollment ID: I20230123001878 |
| Provider Name | Christopher D Nevala-plagemann |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1659725851 PECOS PAC ID: 2567728108 Enrollment ID: I20230213000398 |
| Provider Name | Olga Baeva Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942914395 PECOS PAC ID: 4486026879 Enrollment ID: I20230213000929 |
| Provider Name | Ryley Greenbaum |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1053708669 PECOS PAC ID: 1557662491 Enrollment ID: I20230629000887 |
| Provider Name | Melissa J Cohen |
|---|---|
| Provider Type | Practitioner - Medical Oncology |
| Provider Identifiers | NPI Number: 1174763262 PECOS PAC ID: 0547430613 Enrollment ID: I20230724002209 |
| Provider Name | Hannah E Caulfield |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1093003808 PECOS PAC ID: 4284927534 Enrollment ID: I20230803000542 |
| Provider Name | Adeola Adelayo |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1205996907 PECOS PAC ID: 1557322641 Enrollment ID: I20231009001636 |
| Provider Name | Jennifer Lanzillotta |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1780824144 PECOS PAC ID: 5092867820 Enrollment ID: I20231011001706 |
| Provider Name | Kevin Metz |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1093128712 PECOS PAC ID: 9335528447 Enrollment ID: I20231030001170 |
| Provider Name | Crystal Blackburn |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1851042857 PECOS PAC ID: 4981085388 Enrollment ID: I20231031002421 |
| Provider Name | Roger Blake |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1023049335 PECOS PAC ID: 8022049501 Enrollment ID: I20231114000855 |
| Provider Name | Christina L Gallop |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1992865273 PECOS PAC ID: 2466677109 Enrollment ID: I20231116003145 |
| Provider Name | Carl Allen Woods |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1174550727 PECOS PAC ID: 6103803903 Enrollment ID: I20231201002779 |
| Provider Name | Ann M Bruno |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1881075034 PECOS PAC ID: 3375856958 Enrollment ID: I20240103001612 |
| Provider Name | Nancy Waldrop |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1699303826 PECOS PAC ID: 6507278637 Enrollment ID: I20240118002336 |
| Provider Name | Meredith T Ehn |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1447223656 PECOS PAC ID: 1052393923 Enrollment ID: I20240129000569 |
| Provider Name | Ewa Korzeniowska |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1336514728 PECOS PAC ID: 0648579474 Enrollment ID: I20240130001048 |
| Provider Name | Edward Snyder |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1083792873 PECOS PAC ID: 6204994296 Enrollment ID: I20240131002239 |
| Provider Name | Katelyn Ann Webb |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1821686528 PECOS PAC ID: 3971946971 Enrollment ID: I20240207000233 |
| Provider Name | Jason D Provus |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1972821320 PECOS PAC ID: 9537351960 Enrollment ID: I20240213001081 |
| Provider Name | Nicholas E. Gavern |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1891255071 PECOS PAC ID: 7416375969 Enrollment ID: I20240301002184 |
Ninak Inc. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 170 E Broadway, Jackson, WY 82001 Phone: 307-203-9239 | |
Jh Backcountry Health Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1325 S Hwy 89 Apt 108, Jackson, WY 83001 Phone: 307-699-3447 Fax: 307-939-2266 | |
Urgent Care Of Jackson Hole, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1415 South Highway 89, Jackson, WY 83001 Phone: 307-739-8999 | |
Womens Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 555 E Broadway Suite 108, Jackson, WY 83001 Phone: 307-734-1313 Fax: 307-734-0314 | |
Womens Health & Family Care, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 555 E Broadway Ave Ste 108, Jackson, WY 83001 Phone: 307-734-1313 Fax: 307-734-5003 | |
Imed Utah Heart - Jackson Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 625 E Broadway, Jackson, WY 83001 Phone: 801-507-3500 | |
St Johns Medical Center Physician Services Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: Box 428 625 E Broadway Ave, Jackson, WY 83001 Phone: 307-733-3636 Fax: 307-734-9881 |