Individual provider Active NPI

Lauren Edwards, PTA

  • Physical Therapy Assistant
  • Naperville, IL
National Provider Identifier
1104540434
Registry record updated Sep 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
Practice address
1807 S Washington St Ste 121
Naperville, IL 60565-2052
Phone
(630) 967-2000
NPI assigned
Sep 29, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 29, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X Primary

Addresses

Primary practice location

1807 S Washington St Ste 121
Naperville, IL 60565-2052

Mailing address

25 Crofton Rd
Oswego, IL 60543-8909
Phone (630) 712-1114

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL data

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Dupage Medical Group LTD PastSince Oct 2, 2022 Accepting new patients
Dupage Medical Group LTD PastSince Oct 2, 2022 Accepting new patients

Organizations & group practices 2

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": "1664409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664409600000",
    "number": "1104540434",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 CROFTON RD",
            "city": "OSWEGO",
            "state": "IL",
            "postal_code": "605438909",
            "telephone_number": "630-712-1114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1807 S WASHINGTON ST STE 121",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605652052",
            "telephone_number": "630-967-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "LAUREN",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-29",
        "last_updated": "2022-09-29",
        "certification_date": "2022-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "data",
            "affiliation": "N",
            "address_1": "1807 S Washington St Ste 121",
            "city": "Naperville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605652052",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Naperville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.