DR. WADE TRAVIS BOMENGEN (NPI# 1710959168) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710959168 |
| Entity Type | Individual |
| Full Name | DR. WADE TRAVIS BOMENGEN |
| Credential | M.D. |
| Practice Address |
120 N C Ave Thermopolis WY 82443-2410 |
| Practice Telephone | 3078645534 |
| Practice Fax Number | 3078649470 |
| Mailing Telephone | 3078645534 |
| Mailing Fax Number | 3078649470 |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2012-06-07 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 5946AWY | WY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WY | WY CONTROLLED SUBSTANCE # | 613WB97 | 01 |
| WY | 113009900 | 05 | |
| WY | WY MEDICAL LICENSE # | 5946AWY | 01 |
| WA | DEA | BB5442001 | 01 |
| Street Address |
120 N C AVE |
| City | THERMOPOLIS |
| State | WY |
| Zip Code | 82443-2410 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245719475 | Mitchell F Volin | Physician Assistant | 120 N C Ave, Thermopolis, WY 82443 | 2018-08-08 |
| 1245747872 | Hot Springs County Hospital District | Clinic/Center | 120 N C Ave, Thermopolis, WY 82443-2410 | 2018-01-04 |
| 1508308065 | Linsey Kaye Brooks | Nurse Practitioner | 120 N C Ave, Thermopolis, WY 82443-2410 | 2016-11-14 |
| 1811374010 | Mattson Mathey | Family Medicine | 120 N C Ave, Thermopolis, WY 82443-2410 | 2015-04-27 |
| 1457759300 | Ellen Reynolds | Physician Assistant | 120 N C Ave, Thermopolis, WY 82443-2410 | 2014-12-09 |
| 1255770814 | Hallie Yvonne Bischoff | Family Medicine | 120 N C Ave, Thermopolis, WY 82443-2410 | 2013-06-17 |
| 1063598514 | Joy Lynn Magruder | Family Medicine | 120 N C Ave, Thermopolis, WY 82443-2410 | 2006-10-27 |
| 1114969698 | Thomas E Radosevich | Family Medicine | 120 N C Ave, Thermopolis, WY 82443-2410 | 2006-06-11 |
| 1417902354 | Jason Christopher Weyer | Family Medicine | 120 N C Ave, Thermopolis, WY 82443-2410 | 2006-05-22 |
| 1194792457 | Red Rock Family Practice, PC | Family Medicine | 120 N C Ave, Thermopolis, WY 82443-2410 | 2006-03-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992938419 | Garry Freel | Case Manager/Care Coordinator | 844 Richards St., Thermopolis, WY 82443 | 2009-09-01 |
| 1467600783 | Jantina Anna Manning | Speech-Language Pathologist | 130 Highway 20 South, Thermopolis, WY 82443 | 2008-08-28 |
| 1982882924 | Glenn E Bishop | Chiropractor | 526 Big Horn, Thermopolis, WY 82443 | 2008-02-01 |
| 1801080874 | Karen April Leyba | Speech-Language Pathologist | 1025 Shoshoni Rd, Thermopolis, WY 82443 | 2007-08-31 |
| 1043403199 | Marcia Ann Nelson | Occupational Therapist | 1025 Shoshoni, Childrens Resource Center, Thermopolis, WY 82443 | 2007-08-22 |
| 1639217144 | Northwest Wyoming Boces | Residential Treatment Facility, Emotionally Disturbed Children | 250 East Arapahoe Street, Thermopolis, WY 82443 | 2007-02-05 |
| 1144368366 | Guy C Drake | Dentist | 110 E Arapahoe, Thermopolis, WY 82443 | 2007-02-01 |
| 1639586571 | Mary Margaret Brown | Dentist | 110 E Arapahoe, Thermopolis, WY 82443 | 2014-07-11 |
| 1679813554 | Joseph B. Stringer | Counselor | 121 S 4th St, Thermopolis, WY 82443 | 2013-02-28 |
| 1982932265 | Paintbrush Dental, PC | Clinic/Center | 110 E Arapahoe St, Thermopolis, WY 82443 | 2009-11-25 |
| Find all providers in zip 82443 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811374010 | Mattson Mathey | Family Medicine | 120 N C Ave, Thermopolis, WY 82443-2410 | 2015-04-27 |
| 1255770814 | Hallie Yvonne Bischoff | Family Medicine | 120 N C Ave, Thermopolis, WY 82443-2410 | 2013-06-17 |
| 1063598514 | Joy Lynn Magruder | Family Medicine | 120 N C Ave, Thermopolis, WY 82443-2410 | 2006-10-27 |
| 1114969698 | Thomas E Radosevich | Family Medicine | 120 N C Ave, Thermopolis, WY 82443-2410 | 2006-06-11 |
| 1417902354 | Jason Christopher Weyer | Family Medicine | 120 N C Ave, Thermopolis, WY 82443-2410 | 2006-05-22 |
| 1194792457 | Red Rock Family Practice, PC | Family Medicine | 120 N C Ave, Thermopolis, WY 82443-2410 | 2006-03-07 |
| 1164494241 | Kevin Robert Mahoney | Family Medicine | 120 N C Ave, Thermopolis, WY 82443-2410 | 2006-02-03 |
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|---|---|---|---|---|
| 1265047773 | Backcountry Dox, LLC | Family Medicine | 1320 Morado Dr, Casper, WY 82609 | 2020-09-11 |
| 1639781875 | Relymd Medical Group, LLC | Family Medicine | 1920 Thomes Ave Ste 610, Cheyenne, WY 82001-3548 | 2020-08-19 |
| 1689207722 | South Lincoln Hospital District | Family Medicine | 195 Feather Way Stop 100, Evanston, WY 82930-9352 | 2020-02-18 |
| 1366000580 | Midwest/edgerton Medical Services, Inc. | Family Medicine | 531 Peake St., Midwest, WY 82643 | 2019-06-03 |
| 1164906467 | American Medical Associates, Inc | Family Medicine | 109 E 17th St Ste 25, Cheyenne, WY 82001-4548 | 2018-09-21 |
| 1578057196 | Chere A Bohr | Family Medicine | 2508 E Fox Farm Rd Ste 512, Cheyenne, WY 82007-2559 | 2018-06-18 |
| 1427585488 | Daniel Matthew Bender | Family Medicine | 455 W Broadway Ave, Jackson, WY 83001-8639 | 2017-05-21 |
| 1043747181 | Caroline Lamar Pihl | Family Medicine | 14 Great Plains Road Wind River Family & Community Heal, Arapahoe, WY 82510 | 2017-05-19 |
| 1235503459 | South Lincoln Hospital District | Family Medicine | 195 Feather Way Ste 100, Evanston, WY 82930-9352 | 2015-11-26 |
| 1871994301 | Theresa Marie Karter | Family Medicine | 32 Sage Dr, Cody, WY 82414-8228 | 2014-09-16 |
| Find all providers with the same taxonomy | ||||
| City | THERMOPOLIS |
| Zip Code | 82443 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.