NPIMap

Individual provider Active NPI

David A Edmondson, DO

  • Allergy Physician
  • Wausau, WI
National Provider Identifier
1124079033
Registry record updated Apr 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Allergy PhysicianTaxonomy code 207KA0200X
License
45109 Issued in WI
Practice address
512 S 28TH Ave
Wausau, WI 54401-4147
Phone
(715) 847-2021
Fax
(715) 847-2325
NPI assigned
May 15, 2006
Last updated
Apr 13, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Allergy Physician 207KA0200X 45109 WI Primary
Clinical & Laboratory Immunology (Allergy & Immunology) Physician 207KI0005X 45109 WI

Addresses

Primary practice location

512 S 28TH Ave
Wausau, WI 54401-4147

Mailing address

512 S 28TH Ave
Wausau, WI 54401-4147
Phone (715) 847-2021

Other identifiers 1

IdentifierTypeStateIssuer
008906261NOtherHUMANA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060712000318 WI Practitioner - Allergy/ImmunologyPractitioner - Internal Medicine 2769495860 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Allergy/ImmunologyAlso: Internal Medicine
Education
College of Osteo Med of the Pacific at Pomona, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
ENT and Allergy Associates SCGroup PAC ID 2062429608, 25 clinicians

Practice addresses (Care Compare)

512 S 28TH Ave
Wausau, WI 54401-4147
Phone (715) 847-2021

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.72 of 100Reported as group
Quality
99.98
Promoting interoperability
100
Improvement activities
40
Cost
75.74

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
45109WIMDClinical & Laboratory Immunology (Allergy & Immunology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
ENT & Allergy Associates, S.C. CurrentSince Jul 15, 2006 Accepting new patients
Aspirus Medical Group, Inc. Past Accepting new patients

Locations

5509 Vern Holmes Dr
Stevens Point, WI 54482
Phone (715) 847-2021

2801 Westhill Dr
Wausau, WI 54401
Phone (715) 847-2021

512 S 28th Ave
Wausau, WI 54401
Phone (715) 847-2021

2031 Peach St
Wisconsin Rapids, WI 54494
Phone (715) 423-0122

Interoperability endpoints

  • Direct secure messaging: dedmondson14259@direct.aspirus.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 28

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1147651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586736000000",
    "number": "1124079033",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "512 S 28TH AVE",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544014147",
            "telephone_number": "715-847-2021",
            "fax_number": "715-847-2325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512 S 28TH AVE",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544014147",
            "telephone_number": "715-847-2021",
            "fax_number": "715-847-2325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDMONDSON",
        "first_name": "DAVID",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-15",
        "last_updated": "2020-04-13",
        "certification_date": "2020-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207KA0200X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology, Allergy",
            "state": "WI",
            "license": "45109",
            "primary": true
        },
        {
            "code": "207KI0005X",
            "taxonomy_group": "",
            "desc": "Allergy & Immunology, Clinical & Laboratory Immunology",
            "state": "WI",
            "license": "45109",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA",
            "identifier": "008906261N",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wausau, WI

Sources for this page

Verify at the official NPI Registry.