Benjamin Clayton Edwards, DPT
Individual provider Active NPI Physical Therapist · Grenada, MS
NPI 1356628622 · NPPES record last updated Jun 12, 2014
Key facts
- NPI
- 1356628622
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT4886 (MS)
- Practice address
- 1322C Sunset Dr
Grenada, MS 38901-4000 - Phone
- (662) 294-1007
- Fax
- (662) 294-1079
- NPI assigned
- Nov 14, 2011
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 9
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- University of Mississippi School of Medicine, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Encore Rehabilitation, Inc
Practice addresses (Care Compare)
1322 Sunset Dr C
Grenada, MS 38901-4000
Phone (662) 294-1007
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140821002452 | MS | Practitioner - Physical Therapist in Private Practice | 9234357989 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Encore Rehabilitation, Inc. | Physical Therapist | Current |
Accepting new patients |
| Encore Rehabilitation, Inc. | Physical Therapist | Current |
Accepting new patients |
Locations
251 Johnston St SE
Ste 300
Decatur, AL 35601
Phone (256) 340-9708
1322 Sunset Dr
Ste C
Grenada, MS 38901
Phone (662) 294-1007
433 Main St
Leakesville, MS 39451
Phone (601) 394-4545
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT4886 | MS | Yes |
Addresses
Primary practice location
1322C Sunset Dr
Grenada, MS 38901-4000
Mailing address
PO Box 8419
Biloxi, MS 39535-8087
Phone (662) 294-1007
Other providers in Grenada, MS
- Lillian Lorraine Dubard
- Robert Keith Dubard
- Julie Muselwhite Duke
- Keshia Dukes
- E L Transit Solutions LLC
- Misty Edwards
- Elite Performance Physical Therapy
- Khalihah Ellis
- Tiffany Elmore
- Encore Rehabilitation Inc
All providers in Grenada, MS · Physical Therapist in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 12, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.