AMY R SURDAM NP
NPI 1629099312
Nurse Practitioner in Cheyenne, WY

Q: What is Amy Surdam's NPI number?

The NPI number for Amy Surdam is 1629099312. It was assigned to this individual provider in the NPPES registry on July 21, 2006. The provider is also known as Amy R Forkner No.

Q: What is Amy Surdam's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

Q: When was this NPI record last updated?

The NPPES record for Amy Surdam was last updated on June 28, 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.

Active since July 21, 2006PECOS Enrolled

433 E 19TH ST, CHEYENNE, WY 82001(307) 635-5393(307) 635-2199 Get Directions Write a Review

NPPES record last updated: June 28, 2012. Verified against the NPPES registry weekly; last sync: October 18, 2026.

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About Amy R Surdam Np NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

AMY R SURDAM NP (NPI 1629099312) is an individual nurse practitioner in Cheyenne, Wyoming, licensed in Wyoming (18161.0312) and active in the NPI registry since July 2006. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1629099312

Entity TypeIndividualFemale

Primary Taxonomy363L00000X

Provider Legal NameAMY R SURDAMCredential: NP

Location Address433 E 19TH STCheyenne, WY 82001-4643

Mailing AddressPo Box 20170Cheyenne, WY 82003-7004 · (307) 635-5393 · Fax (307) 635-2199

Phone(307) 635-5393

Fax(307) 635-2199

Sole ProprietorNo

Enumeration DateJuly 21, 2006

Last NPPES UpdateJune 28, 2012

✔ NPI 1629099312 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363L00000X

License✔ Licensed in WY · 18161.0312

Definition

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

433 E 19TH ST, Cheyenne, WY 82001

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Other Names 1

Former Name (1)Amy R Forkner No

Other Identifiers 7

Medicare UPINQ45466WY

Other313763WY · Blue Shield

Medicare ID-Type Unspecified20439WY

Other23339WY · Winhealth Partners

Other82009A055WY · Wps Triwest

OtherP00251860WY · Railroad Medicare

Medicaid121544200WY

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Amy R Surdam Np is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignments

Medicare enrollment records show Amy Surdam reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Care United Medical Center Of Laramie, LLC

40 mi

Multi-Specialty

3810 E GRAND AVE
Laramie, WY 82070

Reassigned Medicare billing, Colorado and Wyoming enrollments
9 clinicians in this Medicare group

NPI 1063720605 (307) 721-1794

Instaclinic, LLC

716 mi

Clinic/Center

7008 QUARTERMILE LN
Dallas, TX 75248

Reassigned Medicare billing, Colorado, Texas and Wyoming enrollments
2 clinicians in this Medicare group

NPI 1659978401 (307) 256-8556

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 82001 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$87.12 typical visit price

range $56.42 – $170.72

Typical copayment $21.78 (range $14.10 – $42.68)

Most-billed visit code 99203

Established Patient

$99.46 typical visit price

range $18.19 – $139.32

Typical copayment $24.86 (range $4.54 – $34.83)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 12

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CIARA CORAL LLC

Clinic/Center (Rehabilitation, Substance Use Disorder)