Individual provider Active NPI

Robert David Edwards, MD

  • Family Medicine Physician
  • Roseville, MI
National Provider Identifier
1073597985
Registry record updated Oct 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301076025 Issued in MI
Practice address
30695 Little Mack Ave
Suite 200
Roseville, MI 48066-1771
Phone
(586) 294-9600
Fax
(586) 294-7570
NPI assigned
Dec 5, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4301076025 MI Primary

Addresses

Primary practice location

30695 Little Mack Ave
Suite 200
Roseville, MI 48066-1771

Mailing address

130 Town Center Dr
Suite 203
Troy, MI 48084-1744
Phone (248) 585-8218

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address redwards78928@direct.beaumont.edu

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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

Enrollment IDStateProvider typePAC IDDetails
I20070907000439 MI Practitioner - Family Practice 1355434382 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Wayne State University School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Oakwood Ambulatory LLCGroup PAC ID 1850282914, 271 clinicians

Practice addresses (Care Compare)

201 3Rd St
Suite 200
Belleville, MI 48111-2605
Phone (734) 697-9065

25631 Little Mack Ave
Suite 103
Saint Clair Shores, MI 48081-2100
Phone (586) 443-2333

Hospital & facility affiliations

  • Beaumont Home Health Home health agency, Troy, MI, CCN 237112
  • Beaumont Hospital - Grosse Pointe Hospital, Grosse Pointe, MI, CCN 230089
  • Beaumont Hospital, Troy Hospital, Troy, MI, CCN 230269
  • Beaumont Hospital Royal Oak Hospital, Royal Oak, MI, CCN 230130

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Oakwood Ambulatory, LLC CurrentSince Jan 3, 2018 Accepting new patients
William Beaumont Hospital Family Medicine CurrentSince Aug 25, 2014 Accepting new patients
William Beaumont Hospital Current Accepting new patients
William Beaumont Hospital CurrentSince Aug 25, 2014 Accepting new patients
William Beaumont Hospital Current Accepting new patients
Oakwood Ambulatory LLC Family Medicine CurrentSince Jan 3, 2018 Accepting new patients
William Beaumont Hospital Past Accepting new patients

Locations

201 3rd St
Ste 200
Belleville, MI 48111
Phone (734) 697-9065

30695 Little Mack Ave
Ste 200
Roseville, MI 48066
Phone (586) 294-9600

3601 W 13 Mile Rd
Royal Oak, MI 48073

30503 Greenfield Rd
Southfield, MI 48076
Phone (248) 691-4732

130 Town Center Dr
Ste 203
Troy, MI 48084
Phone (248) 585-8250

Organizations & group practices 7

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.

Hospital & facility affiliations 5

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": "1133740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603324800000",
    "number": "1073597985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 TOWN CENTER DR",
            "address_2": "SUITE 203",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480841744",
            "telephone_number": "248-585-8218",
            "fax_number": "248-585-8266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30695 LITTLE MACK AVE",
            "address_2": "SUITE 200",
            "city": "ROSEVILLE",
            "state": "MI",
            "postal_code": "480661771",
            "telephone_number": "586-294-9600",
            "fax_number": "586-294-7570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "ROBERT",
        "middle_name": "DAVID",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-05",
        "last_updated": "2020-10-22",
        "certification_date": "2020-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301076025",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "redwards78928@direct.beaumont.edu",
            "affiliation": "N",
            "address_1": "30695 Little Mack Ave",
            "address_2": "Suite 200",
            "city": "Roseville",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480661771",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Roseville, MI

Sources for this page

Verify at the official NPI Registry.