Brandon Edmondson, APRN
Individual provider Active NPI Nurse Practitioner · Soddy Daisy, TN
NPI 1104602093 · NPPES record last updated Sep 6, 2023
Key facts
- NPI
- 1104602093
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 34564 (TN)
- Practice address
- 2027 Ell Rd
Soddy Daisy, TN 37379-8501 - Phone
- (423) 605-9512
- NPI assigned
- Sep 6, 2023
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- East Tennessee State University Quillen College of Medicine, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Crossroads Urgent Care PLLC
Practice addresses (Care Compare)
455 Chickamauga Dr
Suite 104
Dayton, TN 37321-4286
Phone (423) 570-0252
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20231031002890 | TN | Practitioner - Nurse Practitioner | 7113373820 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34564 | TN | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Crossroads Urgent Care PLLC | Nurse Practitioner | Current |
Accepting new patients |
| Crossroads Urgent Care PLLC | Nurse Practitioner | Current |
Accepting new patients |
Locations
455 Chickamauga Dr
Ste 104
Dayton, TN 37321
Phone (423) 570-0252
4490 Hixson Pike
Hixson, TN 37343
Phone (423) 875-0700
2445 Memorial Blvd
Ste C
Murfreesboro, TN 37129
Phone (615) 217-6900
30 Burton Hills Blvd
Ste 175
Nashville, TN 37215
Phone (615) 988-2014
Interoperability endpoints
- brandon.edmondson@488678167609348.direct.elationemr.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 34564 | TN | Yes |
Addresses
Primary practice location
2027 Ell Rd
Soddy Daisy, TN 37379-8501
Mailing address
2027 Ell Rd
Soddy Daisy, TN 37379-8501
Other providers in Soddy Daisy, TN
- Gary Daubert
- April Dent
- Margaret Disheroon
- Karin C. Downs
- Brittany Ann Dunn
- Abbey Roe Elverd
- Amy Katherine Farlett
- Fast Pace Medical Clinic PLLC
- Kathie Lynn Fawbush
- Sarah Flanigan
All providers in Soddy Daisy, TN · Nurse Practitioner in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 6, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.