Edwards Lake Medical Center LLC

Primary specialty

SpecialistTaxonomy code 174400000X

License

00013482 Issued in AL

Legal business name

EDWARDS LAKE MEDICAL CENTER LLC

Practice address

3240 Edwards Lake Pkwy
Suite 204
Birmingham, AL 35235-3117

Phone

(205) 949-1414

Fax

(205) 949-1415

NPI assigned

Aug 31, 2006

Organization subpart

No

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

Authorized official

Name

Jacki Bailey

Title

Billing MGR

Phone

(205) 699-1632

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/HFGCBA

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Andreas Tirso Maddux, MD

  • Nephrology Physician
  • Birmingham, AL
  • NPI 1316985062
  Medicare reassignment NPD

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718841600000",
    "number": "1043321300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3240 EDWARDS LAKE PKWY",
            "address_2": "SUITE 204",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352353117",
            "telephone_number": "205-949-1414",
            "fax_number": "205-949-1415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3240 EDWARDS LAKE PKWY",
            "address_2": "SUITE 204",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352353117",
            "telephone_number": "205-949-1414",
            "fax_number": "205-949-1415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDWARDS LAKE MEDICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2024-06-20",
        "certification_date": "2024-06-20",
        "status": "A",
        "authorized_official_last_name": "BAILEY",
        "authorized_official_first_name": "JACKI",
        "authorized_official_title_or_position": "BILLING MGR",
        "authorized_official_telephone_number": "205-699-1632"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "AL",
            "license": "00013482",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1316985062",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carter Emmett Edmunds
• Hayward Savage Edmunds Jr., M.D.
• Laura Edmundson, MSPT
• Brandon Scott Edney, MD
• Margaret Whitfield Edney
• Adam Larry Edwards, M.D.
• Alexandria Warren Edwards, MD
• Allison Edwards, DPT
• Amanda Britton Edwards, CRNP
• Andrew R Edwards, MD

• Specialist in Birmingham, AL
• Providers in Birmingham, AL by specialty
• Specialist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.