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Active NPI 1629099312 Individual Practitioner Female Practitioner

Amy R Surdam , NP

Nurse Practitioner • Cheyenne, WY

Professional Overview & Biography Verified Profile Summary

Amy Surdam, NP is a registered healthcare professional specializing in Nurse Practitioner in Cheyenne, WY. Practice services are available at 433 E 19TH ST under active NPI credentials.

Frequently performed procedures and clinical services include intramuscular administration of single severe acute respiratory syndrome coronavirus 2 (covid-19) vaccine, mrna-lnp, spike protein, preservative free, 30 mcg/0.3ml dosage, diluent reconstituted; first dose, adm sarscov2 100mcg/0.5ml2nd, established patient outpatient office visit. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

433 E 19th St

Cheyenne, WY 820014643

Telephone 3076355393
Fax 3076352199
Associated Practice Facility / Clinic
🏢 Urology Care Clinic, P.c. Facility NPI 1780754317

Specialty Benchmarks & Practice Insights

Comparative analytics for Nurse Practitioner in Cheyenne, WY

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.0 Yrs
State Avg: 10.6 Yrs
Regional Practice Density
28 Specialists

Practicing in Cheyenne, WY (113 Statewide)

Telehealth Adoption Rate
14.3% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
24.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2021)
Reporting Year:
HCPCS Code & Description Services Patients Submitted Charge Medicare Allowed
0001A Intramuscular administration of single severe acute respiratory syndrome coronavirus 2 (covid-19) vaccine, mrna-lnp, spike protein, preservative free, 30 mcg/0.3ml dosage, diluent reconstituted; first dose
30 30 $23.67 $15.30
0012A Adm sarscov2 100mcg/0.5ml2nd
15 15 $42.67 $34.82

Medical Specialties & State Licenses

Nurse Practitioner Primary Specialty

NUCC Taxonomy Code: 363L00000X

State License WY 18161.0312

(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.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
121544200 (WY)
Commercial Insurance / Payer ID Blue Shield
313763 (WY)
Commercial Insurance / Payer ID Railroad Medicare
P00251860 (WY)
Commercial Insurance / Payer ID Winhealth Partners
23339 (WY)
Commercial Insurance / Payer ID Wps Triwest
82009A055 (WY)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

3 Associated Practitioners
Dr. John Jerstad , MD

Emergency Medicine

NPI 1356365597

Doctor of Medicine (M.D.)

Kristi Roybal , FNP-C

Nurse Practitioner - Family

NPI 1790160679

Family Nurse Practitioner (Certified)

Dr. Arliss Thompson , MD

Emergency Medicine

NPI 1831113752

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events
NPI Profile Active June 28, 2012

NPI status registered as active in NPPES database

📍
Updated Practice Location June 28, 2012

Registered at 433 E 19TH ST, CHEYENNE, WY 820014643 (Tel: 3076355393)

📍
Updated Business Mailing Address June 28, 2012

Registered at PO BOX 20170, CHEYENNE, WY 820037004 (Tel: 3076355393)

👤
Provider Name / Credentials Updated June 28, 2012

Recorded as AMY SURDAM, NP

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) June 28, 2012

Nurse Practitioner (License #18161.0312 in WY)

🟢
Initial NPI Registration & Enumeration July 21, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1629099312
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: July 21, 2006
Last Update: June 28, 2012
Sole Proprietor: No

Mailing Address

Po Box 20170

Cheyenne, WY 820037004

Phone: 3076355393

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.