William John Edmiston Jr., MD

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

License

200000410 Issued in NC

Practice address

170 Medical Park Rd
Suite 301
Mooresville, NC 28117-8540

Phone

(704) 360-4378

Fax

(704) 696-8150

NPI assigned

Aug 30, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Pain ManagementAlso: Anesthesiology

Education

Other, 1991

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Iredell Physician Network LLCGroup PAC ID 0749345007, 91 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Iredell Memorial Hospital Inc Hospital, Statesville, NC, CCN 340039

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: william.edmiston@iredell.cernerdirect.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.

• Iredell Physician Network LLC

  • General Practice Physician
  • Statesville, NC
  • NPI 1811381593
  Medicare reassignment Care Compare group NPD
• Iredell Physician Network LLC

  • Otolaryngology Physician
  • Statesville, NC
  • NPI 1447063920
  NPD
• Surgery Center on Bluefield LLC

  • Ambulatory Surgical Clinic/Center
  • Mooresville, NC
  • NPI 1841019775
  NPD
• Iredell Physician Network LLC

  • Family Medicine Physician
  • Mooresville, NC
  • NPI 1780822288
  NPD (past)
• Lake Norman Anesthesia Associates

  • Specialist
  • Mooresville, NC
  • NPI 1386753457
  NPD (past)

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

• Iredell Memorial Hospital, Incorporated

  • General Acute Care Hospital
  • Statesville, NC
  • NPI 1417944224
  Care Compare affiliation

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1053420190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 MEDICAL PARK RD",
            "address_2": "SUITE 301",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281178540",
            "telephone_number": "704-360-4378",
            "fax_number": "704-696-8150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 MEDICAL PARK RD",
            "address_2": "SUITE 301",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281178540",
            "telephone_number": "704-360-4378",
            "fax_number": "704-696-8150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDMISTON",
        "first_name": "WILLIAM",
        "middle_name": "JOHN",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "NC",
            "license": "200000410",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891269N",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patricia Easton
• Shasta Leann Ebert
• Eckerd Corporation
• Stefani T Eddins
• Edgewater Women'S Health Centre
• Haili Edwards
• Krisandra Marie Edwards, FNP-C
• Gale Egendoerfer
• Adam Ehinger, OTA/L
• Helene Eklen, LCSW

• Interventional Pain Medicine Physician in Mooresville, NC
• Providers in Mooresville, NC by specialty
• Interventional Pain Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.