GOOSE CREEK FAMILY PRACTICE, P.C.
NPI 1134407356
Clinic/Center in Sheridan, WY
About Goose Creek Family Practice, P.c. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
GOOSE CREEK FAMILY PRACTICE, P.C. (NPI 1134407356) is a healthcare organization registered as a clinic/center in Sheridan, Wyoming and active in the NPI registry since July 2011. The organization lists Debra Ann Kawulok, President, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 2
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Goose Creek Family Practice, P.c. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by November 30, 2026
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Goose Creek Family Practice, P.C., which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Goose Creek Family Practice, P.C.'s NPI number?
The NPI number for Goose Creek Family Practice, P.C. is 1134407356. It was assigned to this organization in the NPPES registry on July 22, 2011.
Where is Goose Creek Family Practice, P.C. located?
Goose Creek Family Practice, P.C. is located at 304 Coffeen Ave Suite A, Sheridan, WY 82801. The listed phone number is (307) 674-1744.
What is Goose Creek Family Practice, P.C.'s specialty?
The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.
Is Goose Creek Family Practice, P.C. enrolled in Medicare?
Yes. Goose Creek Family Practice, P.C. is registered in the Medicare PECOS enrollment system.
When is Goose Creek Family Practice, P.C.'s Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Wyoming, Clinic/Group Practice) is due for revalidation by November 30, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Goose Creek Family Practice, P.C.?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Goose Creek Family Practice, P.C.. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
What insurance does Goose Creek Family Practice, P.C. accept?
Health plans from Blue Cross Blue Shield of Wyoming list Goose Creek Family Practice, P.C. as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Goose Creek Family Practice, P.C. was last updated on November 9, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Goose Creek Family Practice, P.c. · NPI 1134407356
Clinic/Center organization in Sheridan, Wyoming. Organization record, active in the CMS NPPES registry since July 22, 2011.
## Identity
- **NPI:** 1134407356 (Entity type: Organization)
- **Enumerated:** July 22, 2011
- **Primary specialty:** Clinic/Center · taxonomy 261Q00000X
- **Organization subpart:** No
- **Authorized official:** Debra Kawulok, PRESIDENT
## Practice location
- **Address:** 304 COFFEEN AVE, SUITE A, Sheridan, WY 82801-4803
- **Phone:** (307) 674-1744 · **Fax:** (307) 674-1752
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** November 30, 2026 (Non-DME Part B, Wyoming, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 1 clinician (Nurse Practitioner) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** November 9, 2012
- **Other identifiers:** Medicare PIN W23011 (WY); Other 1013242502
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Source: [NPI Profile](https://npiprofile.com/npi/1134407356) · Data from the CMS NPPES public registry.