Individual provider Active NPI

Angelena B. Edwards, M.D.

  • Pediatric Urology Physician
  • Louisville, KY
National Provider Identifier
1073856860
Registry record updated Jul 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Urology PhysicianTaxonomy code 2088P0231X
License
59770 Issued in KY
Practice address
3999 Dutchmans LN Ste 6F
Louisville, KY 40207-4724
Phone
(502) 559-1670
Fax
(502) 349-1999
NPI assigned
Apr 1, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X MD-47279 IA
Pediatric Urology Physician 2088P0231X MD-47279 IA
Pediatric Urology Physician 2088P0231X 59770 KY Primary

Addresses

Primary practice location

3999 Dutchmans LN Ste 6F
Louisville, KY 40207-4724

Mailing address

PO Box 776879
Chicago, IL 60677-6879
Phone (502) 588-9490

Other practice location 1

200 Hawkins Dr
Iowa City, IA 52242-1009
Phone (319) 356-0748

Other practice location 2

105 E 9th St
Coralville, IA 52241-2209
Phone (319) 467-2000

Other identifiers 1

IdentifierTypeStateIssuer
1073856860MedicaidKY

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://uichildrens.org/medical-services/urology Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20241106001312 KY Practitioner - UrologyPractitioner - Pediatric Medicine 6709203045 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Norton Children'S Medical Group, LLC Current Accepting new patients
Norton Children'S Medical Group, LLC CurrentSince Sep 1, 2024 Accepting new patients
Norton Children'S Medical Group, LLC CurrentSince Sep 1, 2024 Accepting new patients
Norton Childrens Medical Group, LLC Past Accepting new patients

Locations

601 S Floyd St
Ste 604
Louisville, KY 40202
Phone (502) 559-1670

3999 Dutchmans Ln
Ste 6F
Louisville, KY 40207
Phone (502) 394-1999

3999 Dutchmans Ln
Ste 6FI
Louisville, KY 40207

Interoperability endpoints

  • Direct secure messaging: aedwards181861@uihcdirect.org
  • Direct secure messaging: aedwards60362@direct.nortonhealthcare.org

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1364774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721692800000",
    "number": "1073856860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776879",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606776879",
            "telephone_number": "502-588-9490",
            "fax_number": "502-272-5116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3999 DUTCHMANS LN STE 6F",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402074724",
            "telephone_number": "502-559-1670",
            "fax_number": "502-349-1999"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 Hawkins Dr",
            "address_purpose": "LOCATION",
            "city": "Iowa City",
            "state": "IA",
            "postal_code": "522421009",
            "country_code": "US",
            "telephone_number": "319-356-0748",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "105 E 9th St",
            "address_purpose": "LOCATION",
            "city": "Coralville",
            "state": "IA",
            "postal_code": "522412209",
            "country_code": "US",
            "telephone_number": "319-467-2000",
            "fax_number": "319-467-2410",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "ANGELENA",
        "middle_name": "B.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-04-01",
        "last_updated": "2024-07-23",
        "certification_date": "2024-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "IA",
            "license": "MD-47279",
            "primary": false
        },
        {
            "code": "2088P0231X",
            "taxonomy_group": "",
            "desc": "Urology, Pediatric Urology",
            "state": "IA",
            "license": "MD-47279",
            "primary": false
        },
        {
            "code": "2088P0231X",
            "taxonomy_group": "",
            "desc": "Urology, Pediatric Urology",
            "state": "KY",
            "license": "59770",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1073856860",
            "state": "KY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://uichildrens.org/medical-services/urology",
            "affiliation": "N",
            "endpointDescription": "University of Iowa Department of Urology",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "200 Hawkins Dr",
            "city": "Iowa City",
            "state": "IA",
            "country_code": "US",
            "postal_code": "522421009",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.