GRANT WILSON BERRY (M.D.) – Emergency Medicine Physician, NPI 1174815021

GRANT WILSON BERRY (M.D.) is a healthcare provider. based in Lander, Wyoming. specializing in EMERGENCY MEDICINE. They hold the professional credentials M.D.. They hold a License No. MD043197 (DC). The NPI Number for GRANT WILSON BERRY (M.D.) is 1174815021

Main info

Male
Sole Proprietor
15 Years Of Experience
Accepts Medicare Assignment
Name
GRANT WILSON BERRY (M.D.)
NPI
1174815021
Phone
(202) 550-2819
Address
380 Mount Arter Loop
Enumeration Date
11 May 2011
Last Update Date
20 February 2023

Doctor Profile

Medical School Name
TEXAS TECH UNIVERSITY HEALTH SCIENCE CENTER SCHOOL OF MEDICINE
Secondary Phone
3078564161
Graduation Year
2011 (15 years ago)
PAC ID
4385954783
Group Practice PAC ID
3476462334
Professional Enrollment ID
I20160831002567
Address ID
WY825012274RI2100XDRXX400
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience72
Completeness75
Years active:15State licenses:3Digital endpointsOther names

111 EMERGENCY MEDICINE in WY

Provider Addresses for GRANT WILSON BERRY (M.D.)

  • 380 Mount Arter Loop

    Lander, WY 825202918

    Phone: (202) 550-2819

    Type: Location

  • 214 E 23RD ST

    CHEYENNE, WY 820013748

    Phone: (307) 634-2273

    Type: Mailing

  • PO BOX 1810

    LANDER, WY 825201810

    Phone: (307) 206-4172

    Type: Mailing

  • 2100 W SUNSET DR

    RIVERTON, WY 825012274

    Phone: (307) 857-3445

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2016-08-31

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20160831002567IEmergency MedicineWYTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99285Emergency department visit with high level of medical decision making171157$0
99284Emergency department visit with moderate level of medical decision making6762$0
99283Emergency department visit with low level of medical decision making2524$0
View full utilization report →

Insurance plans in this area (ZIP 82520)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 3476462334View full group profile
NameSpecialtyState
Emergency MedicineTX
Emergency MedicineMI
Emergency MedicineIN
Family Practice, Emergency MedicineOR
-WA
Emergency MedicineOR
Emergency MedicineWA
Emergency MedicineWA
-NY
-WA

Reviews

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Frequently asked questions

What federal number belongs to GRANT WILSON BERRY (M.D.)?
The federal identifier for GRANT WILSON BERRY (M.D.) is NPI 1174815021.
Is GRANT WILSON BERRY (M.D.)'s enrollment marked active?
An active flag here means the NPI record is not in a deactivated state.
What kind of provider is GRANT WILSON BERRY (M.D.)?
The page reflects Emergency Medicine Physician for GRANT WILSON BERRY (M.D.). Clinical services aligned with this taxonomy classification.
Where does public data place GRANT WILSON BERRY (M.D.)?
The snapshot lists Lander, Wyoming for GRANT WILSON BERRY (M.D.); download NPPES for the complete set.
What if Lander, Wyoming seems incomplete?
Street-level detail can be omitted — open the full address list for this NPI.

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