Active NPI
Edson Conrad Hicks Jr., MD
- Specialist
- Phoenix, AZ
National Provider Identifier
1407076201
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 29616
- Practice address
- 4221 E Chandler Blvd Ste 119
Phoenix, AZ 85048-8878 - Phone
- (480) 223-1901
- Fax
- (480) 393-6930
- NPI assigned
- Apr 26, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 29616 | AZ | Primary |
Addresses
Primary practice location
4221 E Chandler Blvd Ste 119
Phoenix, AZ 85048-8878
Mailing address
PO Box 12293
Casa Grande, AZ 85230-2293
Phone (480) 223-1901
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29616 | AZ | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shawn a Tassone MD PLLC | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1407076201",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 12293",
"city": "CASA GRANDE",
"state": "AZ",
"postal_code": "852302293",
"telephone_number": "480-223-1901"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4221 E CHANDLER BLVD STE 119",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850488878",
"telephone_number": "480-223-1901",
"fax_number": "480-393-6930"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HICKS",
"first_name": "EDSON",
"middle_name": "CONRAD",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "AZ",
"license": "29616",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.