Organization Active NPI

Ednem Medical Services, PA

Doing business as Ednem Family Medicine Clinic

  • Family Medicine Physician
  • Orlando, FL
National Provider Identifier
1386783520
Registry record updated Dec 4, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
EDNEM MEDICAL SERVICES, PA
Doing business as
Ednem Family Medicine Clinic
Practice address
7148 Curry Ford Rd Ste 100
Orlando, FL 32822-5803
Phone
(407) 482-2221
Fax
(407) 482-2284
NPI assigned
Feb 5, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2009

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

Authorized official

Name
Dr. Edsel Jeronimo Comenencia, M.D.NPI 1942201561
Title
Physician
Phone
(407) 482-2221

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X FL Primary

Addresses

Primary practice location

7148 Curry Ford Rd Ste 100
Orlando, FL 32822-5803

Mailing address

7148 Curry Ford Rd Ste 100
Orlando, FL 32822-5803
Phone (407) 482-2221

Other identifiers 1

IdentifierTypeStateIssuer
266610300MedicaidFL

Other names 1

  • EDNEM FAMILY MEDICINE CLINIC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041102000250 FL Part B Supplier - Clinic/Group Practice 9537121512 Receives reassigned benefits from 2 practitioners
Practice locations: Orlando, FL

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D1012531Ednem Family Medicine Clinic7148 Curry Ford Rd Ste 100, Orlando, FL 32822Certificate of waiverMay 12, 2027

National Provider Directory

National Provider Directory

Locations

7148 Curry Ford Rd
Ste 100
Orlando, FL 32822
Phone (407) 482-2221

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1259884800000",
    "number": "1386783520",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7148 CURRY FORD RD STE 100",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328225803",
            "telephone_number": "407-482-2221",
            "fax_number": "407-482-2284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7148 CURRY FORD RD STE 100",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328225803",
            "telephone_number": "407-482-2221",
            "fax_number": "407-482-2284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDNEM MEDICAL SERVICES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-05",
        "last_updated": "2009-12-04",
        "status": "A",
        "authorized_official_last_name": "COMENENCIA",
        "authorized_official_first_name": "EDSEL",
        "authorized_official_middle_name": "JERONIMO",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "407-482-2221",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "266610300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EDNEM FAMILY MEDICINE CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.