Individual provider Active NPI

Alexander Allan Edwards, PA-C

  • Physician Assistant
  • Bolingbrook, IL
National Provider Identifier
1356036644
Registry record updated Oct 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
732923 Issued in WI
Practice address
431 Remington Blvd
Bolingbrook, IL 60440-4918
Phone
(872) 231-3162
NPI assigned
Apr 11, 2023
Last updated
Oct 7, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 7, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 732923 WI Primary
Physician Assistant 363A00000X 085.009553 IL

Addresses

Primary practice location

431 Remington Blvd
Bolingbrook, IL 60440-4918

Mailing address

PO Box 74008272
Chicago, IL 60674-8272
Phone (702) 899-0595

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, IL2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20240301001290 WI Practitioner - Physician Assistant 0446695332 Reassigns benefits to 3 organizations
I20241004001652 IL Practitioner - Physician Assistant 0446695332 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Radial Wound PLLCGroup PAC ID 4082140918, 7 clinicians

Practice addresses (Care Compare)

Chicago, IL 60611
Phone (872) 321-3162

3217 Fiddlers Creek Dr
Waukesha, WI 53188-3946
Phone (312) 635-0973

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085.009553ILMDPhysician Assistant
732923WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Physicians, S.C. CurrentSince Oct 7, 2025 Accepting new patients
Integrated Rehab Consultants LLC CurrentSince Apr 28, 2025 Accepting new patients

Locations

401 N Michigan Ave
Ste 1200
Chicago, IL 60611
Phone (224) 496-6940

16101 Weber Rd
Crest Hill, IL 60403
Phone (815) 306-1100

134 N McLean Blvd
Elgin, IL 60123
Phone (773) 463-5383

14330 S Will Cook Rd
Homer Glen, IL 60491
Phone (708) 645-0288

3705 Deerfield Rd
Riverwoods, IL 60015
Phone (847) 459-1200

6201 Elmwood Ave
Middleton, WI 53562
Phone (608) 830-5141

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1681171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759795200000",
    "number": "1356036644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 74008272",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606748272",
            "telephone_number": "702-899-0595",
            "fax_number": "702-977-1496"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "431 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404918",
            "telephone_number": "872-231-3162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "ALEXANDER",
        "middle_name": "ALLAN",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-04-11",
        "last_updated": "2025-10-07",
        "certification_date": "2025-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "732923",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085.009553",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bolingbrook, IL

Sources for this page

Verify at the official NPI Registry.