Edwards Clinic, PSC

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

EDWARDS CLINIC, PSC

Practice address

204 Town Branch Road
Manchester, KY 40962-1322

Phone

(606) 598-8766

Fax

(606) 598-1903

NPI assigned

Jul 28, 2010

Last updated

Apr 22, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Dana Edwards, MDNPI 1164424131

Title

President

Phone

(606) 598-8766

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in KY2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1154635407. Details of each certification follow.

• CCN B03968 Rural health clinic · Active · Details

Rural health clinic certification: CCN B03968

Legal name

EDWARDS CLINIC PSC

Certification status

Active

Provider type (POS)

Rural health clinic

Participating since

Jan 28, 2025

Last certification

Jan 28, 2025

Ownership / control type

1A

Organization structure

CorporationProprietary

Incorporated

Dec 1, 1998 in KY

Enrollment address

204 Town Branch Rd
Manchester, KY 40962-1322

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 1

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Dana Phillip Edwards, M.D.

  • Surgery Physician
  • Manchester, KY
  • NPI 1164424131

  5% Or Greater Direct Ownership Interest, Corporate Officer, Operational/Managerial Control

  CMS ownership

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Dana Phillip Edwards, M.D.

  • Surgery Physician
  • Manchester, KY
  • NPI 1164424131
  Medicare reassignment NPD Authorized official
• Anita F Cornett, MD

  • Internal Medicine Physician
  • Manchester, KY
  • NPI 1770553463
  Medicare reassignment NPD
• Eva Angel Edwards, APRN,FNP-BC,RFNA,CNO

  • Family Nurse Practitioner
  • Manchester, KY
  • NPI 1396964102
  Medicare reassignment NPD
• Betty Alevras, APRN

  • Family Nurse Practitioner
  • Manchester, KY
  • NPI 1346627296
  NPD (past)
• Veronica L Boley, APRN

  • Family Nurse Practitioner
  • Gray, KY
  • NPI 1457784159
  NPD (past)
• Kristina Michelle Byrd, APRN, FNP-C

  • Family Nurse Practitioner
  • Booneville, KY
  • NPI 1326498338
  NPD (past)
• Natalie Nicole Gross, APRN, FNP-C

  • Family Nurse Practitioner
  • Manchester, KY
  • NPI 1962146779
  NPD (past)
• Amber Henson, APRN

  • Family Nurse Practitioner
  • Manchester, KY
  • NPI 1205386786
  NPD (past)
• Jill S Jones, MD

  • Family Medicine Physician
  • Erlanger, KY
  • NPI 1649229352
  NPD (past)
• Sandra Pennington, APRN

  • Family Nurse Practitioner
  • Manchester, KY
  • NPI 1649005471
  NPD (past)
• Kayla Roach, APRN

  • Family Nurse Practitioner
  • Manchester, KY
  • NPI 1205606282
  NPD (past)
• Tammy S. Saylor, APRN

  • Family Nurse Practitioner
  • Gray, KY
  • NPI 1821439746
  NPD (past)

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

{
    "created_epoch": "1280275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745280000000",
    "number": "1154635407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 TOWN BRANCH RD",
            "city": "MANCHESTER",
            "state": "KY",
            "postal_code": "409621322",
            "telephone_number": "606-598-8766",
            "fax_number": "606-598-1903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 TOWN BRANCH ROAD",
            "city": "MANCHESTER",
            "state": "KY",
            "postal_code": "409621322",
            "telephone_number": "606-598-8766",
            "fax_number": "606-598-1903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDWARDS CLINIC, PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-28",
        "last_updated": "2025-04-22",
        "certification_date": "2025-04-22",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "DANA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "606-598-8766",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "KY",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "KY",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• G. Eldon Depew, PHARM D
• Suvas Ghelabhai Desai, MD
• Cindy Dezarn, MSPT
• Diabetic Health, Inc.
• East Bernstadt Medical Clinic PLLC (Burning Springs Medical Clinic)
• Dana Phillip Edwards, M.D.
• Eva Angel Edwards, APRN,FNP-BC,RFNA,CNO
• Ahmed El Gammal, MD
• Kelly Evans, D.O.
• Express Care Pharmacy LLC

• Rural Health Clinic/Center in Manchester, KY
• Providers in Manchester, KY by specialty
• Rural Health Clinic/Center in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.