NPIMap

Individual provider Active NPI

George Roger Edelen, MD

  • Pain Medicine (Anesthesiology) Physician
  • Casa Grande, AZ
National Provider Identifier
1114960887
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
30267 Issued in AZ
Practice address
1653 E McMurray Blvd
Suite 144
Casa Grande, AZ 85122-5934
Phone
(520) 836-8644
Fax
(520) 836-2499
NPI assigned
Jun 13, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) Physician 207LP2900X 30267 AZ Primary

Addresses

Primary practice location

1653 E McMurray Blvd
Suite 144
Casa Grande, AZ 85122-5934

Mailing address

1653 E McMurray Blvd Ste 144
Casa Grande, AZ 85122-5934
Phone (520) 836-8644

Other identifiers 1

IdentifierTypeStateIssuer
707698MedicaidAZ

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)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Arizona Diagnostic & Surgical Center, Inc Past Accepting new patients
Clinical Partners PA Anesthesiology Past Accepting new patients
Verde Valley Medical Center Past Accepting new patients

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1114960887",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1653 E MCMURRAY BLVD STE 144",
            "city": "CASA GRANDE",
            "state": "AZ",
            "postal_code": "851225934",
            "telephone_number": "520-836-8644",
            "fax_number": "520-836-2499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1653 E MCMURRAY BLVD",
            "address_2": "SUITE 144",
            "city": "CASA GRANDE",
            "state": "AZ",
            "postal_code": "851225934",
            "telephone_number": "520-836-8644",
            "fax_number": "520-836-2499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDELEN",
        "first_name": "GEORGE",
        "middle_name": "ROGER",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-13",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "AZ",
            "license": "30267",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "707698",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Casa Grande, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.