Individual provider Active NPI

Brian Thomas Edmondson, LCSW

  • Clinical Social Worker
  • Oklahoma City, OK
National Provider Identifier
1407020555
Registry record updated Apr 19, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
3549 Issued in OK
Practice address
5009 N Pennsylvania Ave
Suite 116
Oklahoma City, OK 73112-8888
Phone
(405) 843-1551
Fax
(405) 843-1494
NPI assigned
Apr 19, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 19, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 3549 OK Primary

Addresses

Primary practice location

5009 N Pennsylvania Ave
Suite 116
Oklahoma City, OK 73112-8888

Mailing address

5009 N Pennsylvania Ave
Suite 116
Oklahoma City, OK 73112-8888
Phone (405) 843-1551

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081114000253 OK Practitioner - Clinical Social Worker 0547320020 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Edmondson Counseling Services PCGroup PAC ID 6800946831, 3 clinicians

Practice addresses (Care Compare)

6801 Broadway Ext
Suite 320
Oklahoma City, OK 73116-9037
Phone (405) 843-1551

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Sally Ray Inc Clinical Past Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1208563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208563200000",
    "number": "1407020555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5009 N PENNSYLVANIA AVE",
            "address_2": "SUITE 116",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731128888",
            "telephone_number": "405-843-1551",
            "fax_number": "405-843-1494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5009 N PENNSYLVANIA AVE",
            "address_2": "SUITE 116",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731128888",
            "telephone_number": "405-843-1551",
            "fax_number": "405-843-1494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDMONDSON",
        "first_name": "BRIAN",
        "middle_name": "THOMAS",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-04-19",
        "last_updated": "2008-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OK",
            "license": "3549",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.