Individual provider Active NPI

Elizabeth Ann Edwards, FNP-BC

  • Family Medicine Physician
  • Colonial Heights, VA
National Provider Identifier
1174292429
Registry record updated May 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0024182391 Issued in VA
Practice address
524 Southpark Blvd
Colonial Heights, VA 23834-3609
Phone
(804) 504-7980
Fax
(804) 554-5387
NPI assigned
Sep 9, 2021
Last updated
May 11, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 11, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 0024182391 VA Primary

Addresses

Primary practice location

524 Southpark Blvd
Colonial Heights, VA 23834-3609

Mailing address

524 Southpark Blvd
Colonial Heights, VA 23834-3609
Phone (804) 504-7980

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220613001776 VA Practitioner - Nurse Practitioner 9436537925 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Female Pelvic Medicine Institute of Virginia PCGroup PAC ID 6709927957, 2 clinicians

Practice addresses (Care Compare)

2931 Polo Pkwy
Midlothian, VA 23113-1453
Phone (804) 523-2533

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0024182391VAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jencare Neighborhood Medical South Park LLC CurrentSince May 16, 2022 Accepting new patients
Family Practice Associates of Chesterfield PC Family Medicine PastSince Sep 1, 2021 Accepting new patients
Jencare Neighborhood Medical East Richmond, LLC PastSince Sep 4, 2012 Accepting new patients

Locations

1395 NW 167th St
Miami Gardens, FL 33169
Phone (305) 831-4760

524 Southpark Blvd
Colonial Hgts, VA 23834
Phone (804) 504-7980

Organizations & group practices 4

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 1

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

NPI Registry JSON

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

{
    "created_epoch": "1631145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652227200000",
    "number": "1174292429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "524 SOUTHPARK BLVD",
            "city": "COLONIAL HEIGHTS",
            "state": "VA",
            "postal_code": "238343609",
            "telephone_number": "804-504-7980",
            "fax_number": "804-554-5387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "524 SOUTHPARK BLVD",
            "city": "COLONIAL HEIGHTS",
            "state": "VA",
            "postal_code": "238343609",
            "telephone_number": "804-504-7980",
            "fax_number": "804-554-5387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "ELIZABETH",
        "middle_name": "ANN",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-09",
        "last_updated": "2022-05-11",
        "certification_date": "2022-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0024182391",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colonial Heights, VA

Sources for this page

Verify at the official NPI Registry.