NPIMap

Individual provider Active NPI

Mark Thomas Edge, PHD MD

  • Diagnostic Radiology Physician
  • Gastonia, NC
National Provider Identifier
1003899766
Registry record updated Aug 23, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
200200890 Issued in NC
Practice address
620 Summit Crossing PL
Ste 106
Gastonia, NC 28054
Phone
(704) 867-8021
Fax
(704) 864-4606
NPI assigned
Nov 26, 2005
Last updated
Aug 23, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neuroradiology Physician 2085N0700X 200200890 NC
Diagnostic Radiology Physician 2085R0202X 200200890 NC Primary

Addresses

Primary practice location

620 Summit Crossing PL
Ste 106
Gastonia, NC 28054

Mailing address

620 Summit Crossing PL
Ste 106
Gastonia, NC 28054
Phone (704) 867-8021

Other identifiers 9

IdentifierTypeStateIssuer
D4988OtherMEDCOST
N0089DMedicaidSC
560988142OtherUNITED HEALTHCARE
3616445OtherAETNA HMO
89132UHMedicaidNC
132UHOtherBLUE CROSS BLUE SHIELD
7436626OtherAETNA PPO
801319OtherPARTNERS
P00167818OtherRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040907001292 NC Practitioner - Diagnostic Radiology 2860468238 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Alabama School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gaston Radiology PAGroup PAC ID 4082680806, 29 clinicians

Practice addresses (Care Compare)

620 Summit Crossing Place
Suite 106
Gastonia, NC 28054-2176
Phone (704) 864-4378

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.22 of 100Reported as group
Quality
95.56
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine, Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
200200890NCMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Gaston Radiology Diagnostic Radiology Current Accepting new patients
Gaston Radiology PA Diagnostic Radiology CurrentSince Jul 1, 2004 Accepting new patients
Wake Forest University Health Sciences Past Accepting new patients

Locations

2525 Court Dr
Gastonia, NC 28054
Phone (704) 834-2662

620 Summit Crossing Pl
Ste 106
Gastonia, NC 28054
Phone (704) 864-4378

336 Burtonwood Dr
Gastonia, NC 28054
Phone (704) 867-8021

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1132963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1282521600000",
    "number": "1003899766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 SUMMIT CROSSING PL",
            "address_2": "STE 106",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "28054",
            "telephone_number": "704-867-8021",
            "fax_number": "704-864-4606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 SUMMIT CROSSING PL",
            "address_2": "STE 106",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "28054",
            "telephone_number": "704-867-8021",
            "fax_number": "704-864-4606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDGE",
        "first_name": "MARK",
        "middle_name": "THOMAS",
        "credential": "PHD MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-26",
        "last_updated": "2010-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "NC",
            "license": "200200890",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NC",
            "license": "200200890",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "D4988",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "N0089D",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "560988142",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA HMO",
            "identifier": "3616445",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89132UH",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "132UH",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PPO",
            "identifier": "7436626",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARTNERS",
            "identifier": "801319",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00167818",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gastonia, NC

Sources for this page

Verify at the official NPI Registry.