Edgar Prentiss Coltharp Jr., PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

729 Issued in AK

Practice address

3300 Arctic Blvd
# 101
Anchorage, AK 99503-4523

Phone

(907) 561-3488

Fax

(907) 562-3488

NPI assigned

Mar 6, 2007

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 1, 2012 through Apr 1, 2028

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• MD Inc

  • Internal Medicine Physician
  • Anchorage, AK
  • NPI 1003914094
  NPD (past)

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1104956515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12032 COPPER MOUNTAIN DR",
            "city": "EAGLE RIVER",
            "state": "AK",
            "postal_code": "995777304",
            "telephone_number": "907-694-1173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 ARCTIC BLVD",
            "address_2": "# 101",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995034523",
            "telephone_number": "907-561-3488",
            "fax_number": "907-562-3488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLTHARP",
        "first_name": "EDGAR",
        "middle_name": "PRENTISS",
        "name_suffix": "Jr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-06",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AK",
            "license": "729",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tamara Bell Collins, LMT
• Omaira Colon Rodriguez, M.D.
• Jason Colon, OTRL
• Laurie Lee Colston, CPNP
• Patrice Colston, P.A.-C
• Michelle Coltrane, RN
• Ivan Mauricio Guillermo Columbus Morales, MD
• Andrea Combs
• Connie Combs
• Gail Ann Combs, PA-C

• All providers in Anchorage, AK
• Physician Assistant in Alaska

• 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.