Jennifer Lynn Edwards, CFA

Primary specialty

Surgical AssistantTaxonomy code 246ZC0007X

License

238000175 Issued in IL

Practice address

120 NE Glen Oak Ave Ste 407
Peoria, IL 61603-4301

Phone

(309) 672-5975

Fax

(309) 655-1678

NPI assigned

Oct 26, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Mid Illini Surgical Associates SC

  • Surgery Physician
  • Peoria, IL
  • NPI 1093854002
  NPD (past)

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

{
    "created_epoch": "1193356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193356800000",
    "number": "1215116124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 NE GLEN OAK AVE STE 407",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616034301",
            "telephone_number": "309-672-5975",
            "fax_number": "309-655-1678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 NE GLEN OAK AVE STE 407",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616034301",
            "telephone_number": "309-672-5975",
            "fax_number": "309-655-1678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "JENNIFER",
        "middle_name": "LYNN",
        "credential": "CFA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-26",
        "last_updated": "2007-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": "IL",
            "license": "238000175",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SURGICAL TECHNICIANS",
            "identifier": "106370",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Courtney D Edsall, APRN
• Edward C Luan MD SC
• Edward L Rick DDS,Ms,PC
• Charles Thomas Edwards, PT
• Deja Edwards
• Keith Edwards
• Patricia J Edwards, LCSW
• Elizabeth Eells, R.D. L.D.N
• Andrea Joy Eertmoed
• Alison B Eeten, CNP

• Surgical Assistant in Peoria, IL
• Providers in Peoria, IL by specialty
• Surgical Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.