Individual provider Active NPI

Edward Canada, LCSW

  • Clinical Social Worker
  • Richmond, VA
National Provider Identifier
1174680466
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
0904001407 Issued in VA
Practice address
200 N 22ND St
Richmond, VA 23223-7020
Phone
(804) 644-9590
Fax
(804) 649-2151
NPI assigned
Jan 3, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 0904001407 VA Primary

Addresses

Primary practice location

200 N 22ND St
Richmond, VA 23223-7020

Mailing address

200 N 22ND St
Richmond, VA 23223-7020
Phone (804) 644-9590

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110523000711 VA Practitioner - Clinical Social Worker 9931385150 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1984
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Virginia South Psychiatric and Family ServicesGroup PAC ID 3476443797, 35 clinicians

Practice addresses (Care Compare)

207 N 4TH Ave
Hopewell, VA 23860-2503
Phone (804) 518-6513

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Virginia South Psychiatric & Family Services CurrentSince Jun 15, 2011 Accepting new patients
Three Rivers Treatment Center LLC Past Accepting new patients

Locations

207 N 4th Ave
Hopewell, VA 23860
Phone (804) 518-6513

269 Medical Park Blvd
Petersburg, VA 23805
Phone (804) 861-0700

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.72142

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1174680466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 N 22ND ST",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232237020",
            "telephone_number": "804-644-9590",
            "fax_number": "804-649-2151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 N 22ND ST",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232237020",
            "telephone_number": "804-644-9590",
            "fax_number": "804-649-2151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANADA",
        "first_name": "EDWARD",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VA",
            "license": "0904001407",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Richmond, VA

Sources for this page

Verify at the official NPI Registry.