Jordan Lee Edwards, NP-C

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

2019026971 Issued in MO

Practice address

105 Creekside Office Dr
Wentzville, MO 63385-3289

Phone

(636) 625-5200

NPI assigned

Oct 15, 2019

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sound Physicians of Illinois LLCGroup PAC ID 1557533734, 193 clinicians

Ria Medical LLCGroup PAC ID 6608834395, 5 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northwestern Medicine Central Dupage Hospital Hospital, Winfield, IL, CCN 140242
• SSM St Joseph Hospital West Hospital, Lake Saint Louis, MO, CCN 260200

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/24426/brand/1/csg/1/fhir/r4
• Direct secure messaging: jordan.edwards.1@24426.direct.athenahealth.com

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

• Ria Medical, LLC

  • Internal Medicine Physician
  • Wentzville, MO
  • NPI 1174615025
  Medicare reassignment Care Compare group NPD
• Sound Physicians of Illinois, LLC

  • Hospitalist Physician
  • Bridgeton, MO
  • NPI 1043598865
  Medicare reassignment Care Compare group
• Midwest Innovation Laboratory LLC

  • Clinical Medical Laboratory
  • Saint Louis, MO
  • NPI 1942825633
  NPD (past)

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

• SSM Health Care St. Louis

  • General Acute Care Hospital
  • Lake St Louis, MO
  • NPI 1871665380
  Care Compare affiliation
• Central Dupage Hospital Association

  • General Acute Care Hospital
  • Winfield, IL
  • NPI 1003864810
  Care Compare affiliation
• Central Dupage Hospital Association

  • Psychiatric Hospital Unit
  • Winfield, IL
  • NPI 1740230895
  Care Compare affiliation

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

{
    "created_epoch": "1571097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571702400000",
    "number": "1043852775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 VININGS BLVD",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633667582",
            "telephone_number": "870-634-6883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 CREEKSIDE OFFICE DR",
            "city": "WENTZVILLE",
            "state": "MO",
            "postal_code": "633853289",
            "telephone_number": "636-625-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "JORDAN",
        "middle_name": "LEE",
        "credential": "NP-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-10-15",
        "last_updated": "2019-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MO",
            "license": "2019026971",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lindsay Durdle, OTR/L
• Linda Duree, LPC
• Kyle J Eash, M.D. PH.D.
• Ec Med Services LLC
• Edify Home Health Services LLC
• Pappa Umonoibalo Ehimare, MD
• Erica Elder, PHARMD
• Elevate Care Providers LLC
• Jeffery William Ellis, RPH
• Peggy Ellis

• Adult Health Nurse Practitioner in Wentzville, MO
• Providers in Wentzville, MO by specialty
• Adult Health Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.