Active NPI
Edwin Lysle Price, RPAC
- Medical Physician Assistant
- Derby, KS
National Provider Identifier
1124129911
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- 15-00248
- Practice address
- 606 Mulberry Rd
Derby, KS 67037-3532 - Phone
- (316) 788-3787
- Fax
- (316) 788-6930
- NPI assigned
- Sep 26, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 15-00248 | KS | Primary |
Addresses
Primary practice location
606 Mulberry Rd
Derby, KS 67037-3532
Mailing address
1725 Tiara Pines Dr
Derby, KS 67037-3933
Phone (316) 788-5369
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 15-00248 | Other | KS | KS ST BOARD LICENSE |
| P00099501 | Other | KS | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KS
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15-00248 | KS | MD | Medical Physician Assistant |
Interoperability endpoints
- lysle.price@tfmc.directbygreenway.com
- edwin.price@khindirect.org
Organizations & group practices 1
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.
-
- Family Medicine Physician
- Derby, KS
- NPI 1659472306
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1374192000000",
"number": "1124129911",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1725 TIARA PINES DR",
"city": "DERBY",
"state": "KS",
"postal_code": "670373933",
"telephone_number": "316-788-5369"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "606 MULBERRY RD",
"city": "DERBY",
"state": "KS",
"postal_code": "670373532",
"telephone_number": "316-788-3787",
"fax_number": "316-788-6930"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRICE",
"first_name": "EDWIN",
"middle_name": "LYSLE",
"name_prefix": "Mr.",
"credential": "RPAC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-26",
"last_updated": "2013-07-19",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "KS",
"license": "15-00248",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KS ST BOARD LICENSE",
"identifier": "15-00248",
"state": "KS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00099501",
"state": "KS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Derby, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2013; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.