NPIMap

Individual provider Active NPI

Jacob Edens, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Royal Oak, MI
National Provider Identifier
1356791768
Registry record updated May 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
4301501530 Issued in MI
Practice address
3601 W 13 Mile Rd
Royal Oak, MI 48073-6712
Phone
(509) 385-6925
NPI assigned
Jun 16, 2016
Last updated
May 29, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 29, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 4301110310 MI
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 4301501530 MI Primary

Addresses

Primary practice location

3601 W 13 Mile Rd
Royal Oak, MI 48073-6712

Mailing address

22101 Moross Rd
Detroit, MI 48236-2148

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220822003537 KY Practitioner - Pathology 9931506763 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Chipps, Caffrey and Dubilier, P.S.CGroup PAC ID 4688573900, 19 clinicians

Practice addresses (Care Compare)

290 Big Run Rd
Lexington, KY 40503-2903
Phone (859) 278-9513

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301501530MIMDAnatomic Pathology & Clinical Pathology Physician
4301110310MIMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Arh Mary Breckinridge Health Services, Inc. CurrentSince Jul 1, 2022 Accepting new patients
Arh Mary Breckinridge Health Services, Inc. Current Accepting new patients
Chipps, Caffrey & Dubilier, P.S.C Anatomic Pathology & Clinical Pathology CurrentSince Nov 4, 2023 Accepting new patients
Appalachian Regional Healthcare, Inc. Current Accepting new patients
Appalachian Regional Healthcare, Inc CurrentSince Jul 1, 2022 Accepting new patients
Appalachian Regional Healthcare, Inc CurrentSince Jul 1, 2022 Accepting new patients
Appalachian Regional Healthcare, Inc Anatomic Pathology & Clinical Pathology Current Accepting new patients
Genetic Services of Louisiana Past Accepting new patients

Locations

80 Hospital Dr
Barbourville, KY 40906
Phone (606) 545-5500

100 Airport Gardens Rd
Hazard, KY 41701
Phone (606) 216-5145

100 Medical Dr
Hazard, KY 41701
Phone (606) 439-6600

290 Big Run Rd
Lexington, KY 40503

2004 Cumberland Ave
Ste 100
Middlesboro, KY 40965
Phone (606) 248-3015

3600 Cumberland Ave
Middlesboro, KY 40965
Phone (606) 237-1700

2662 King Kelly Coleman Hwy
Wayland, KY 41666
Phone (606) 358-4211

240 Hospital Rd
Whitesburg, KY 41858
Phone (606) 633-3500

Interoperability endpoints

  • Direct secure messaging: jedens539471@direct.hfhs.org

Organizations & group practices 8

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.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1466035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590710400000",
    "number": "1356791768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22101 MOROSS RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482362148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3601 W 13 MILE RD",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480736712",
            "telephone_number": "509-385-6925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDENS",
        "first_name": "JACOB",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-06-16",
        "last_updated": "2020-05-29",
        "certification_date": "2020-05-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MI",
            "license": "4301110310",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "MI",
            "license": "4301501530",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Royal Oak, MI

Sources for this page

Verify at the official NPI Registry.