NPIMap

Individual provider Active NPI

Paul Michael Edlebeck

  • Family Medicine Physician
  • Midland, MI
National Provider Identifier
1376287722
Registry record updated Apr 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4351049280 Issued in MI
Practice address
4611 Campus Ridge Dr
Midland, MI 48640-9533
Phone
(906) 282-8768
NPI assigned
Apr 22, 2022
Last updated
Apr 22, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4351049280 MI Primary

Addresses

Primary practice location

4611 Campus Ridge Dr
Midland, MI 48640-9533

Mailing address

4000 Wellness Drive
Midland Mall
Midland, MI 48670
Phone (844) 832-1956

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20250728000469 MI Practitioner - Family Practice 7416337761 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Michigan State University College of Human Medicine, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mymichigan Medical Center MidlandGroup PAC ID 2264323633, 507 clinicians

Practice addresses (Care Compare)

4401 Campus Ridge Dr
Suite 2100
Midland, MI 48640-6125
Phone (989) 837-9300

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mymichigan Medical Center Midland Family Medicine CurrentSince Jul 22, 2025 Accepting new patients
Mymichigan Medical Center Midland CurrentSince Jul 22, 2025 Accepting new patients

Locations

4000 Wellness Dr
Midland, MI 48670
Phone (844) 832-1956

4401 N Campus Ridge Dr
Ste 2100
Midland, MI 48640
Phone (989) 837-9300

4500 N Campus Ridge Dr
Midland, MI 48640
Phone (989) 837-9250

4611 N Campus Ridge Dr
Midland, MI 48640
Phone (844) 832-1956

Interoperability endpoints

  • Direct secure messaging: pedlebeck96394@mymichiganhealth.midirect.net

Organizations & group practices 2

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 9

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": "1650585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650585600000",
    "number": "1376287722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 WELLNESS DRIVE",
            "address_2": "MIDLAND MALL",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "48670",
            "telephone_number": "844-832-1956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4611 CAMPUS RIDGE DR",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "486409533",
            "telephone_number": "906-282-8768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDLEBECK",
        "first_name": "PAUL",
        "middle_name": "MICHAEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-22",
        "last_updated": "2022-04-22",
        "certification_date": "2022-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4351049280",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Midland, MI

Sources for this page

Verify at the official NPI Registry.