Edgar M Conrad IV, LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

107748 Issued in MO

Legal business name

EDGAR M CONRAD IV, LLC

Practice address

2700 Cunningham Ave
Suite 103
Joplin, MO 64801-1570

Phone

(417) 782-3292

Fax

(417) 782-4024

NPI assigned

Jun 13, 2008

Last updated

Aug 11, 2008By 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. Edgar M Conrad IV, DONPI 1124055074

Title

Proprietor

Phone

(414) 782-3292

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Locations

Practitioners 1

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.

• Edgar M. Conrad IV, D.O.

  • Internal Medicine Physician
  • Joplin, MO
  • NPI 1124055074
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1213315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218412800000",
    "number": "1336309228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 CUNNINGHAM AVE",
            "address_2": "SUITE 103",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648011570",
            "telephone_number": "417-782-3292",
            "fax_number": "417-782-4024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 CUNNINGHAM AVE",
            "address_2": "SUITE 103",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648011570",
            "telephone_number": "417-782-3292",
            "fax_number": "417-782-4024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGAR M CONRAD IV, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-13",
        "last_updated": "2008-08-11",
        "status": "A",
        "authorized_official_last_name": "CONRAD",
        "authorized_official_first_name": "EDGAR",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PROPRIETOR",
        "authorized_official_telephone_number": "414-782-3292",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "IV",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MO",
            "license": "107748",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "248016636",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bobbi Eckert
• Valerie M Eckhard, CRNA
• Economic Security Corporation of Southwest Area (Women's Health and Family Planning Clinic)
• Lerin D Eddings
• Cristy Leigh Edens, DNP
• Megan Edie
• Cary Dawn Edwards, C.R.N.A.
• Ronald David Edwards, MD
• Samantha Egbert
• David Odinga Egessah, OTR L

• Internal Medicine Physician in Joplin, MO
• Providers in Joplin, MO by specialty
• Internal Medicine Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.