NPIMap

Organization Active NPI

Edge Medical Care PC

  • Primary Care Clinic/Center
  • Riverdale, MD
National Provider Identifier
1447255609
Registry record updated Jul 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
D 47156 Issued in MD
Legal business name
EDGE MEDICAL CARE PC
Practice address
5305 Kenilworth Ave
Ste 100
Riverdale, MD 20737-3110
Phone
(301) 277-7110
NPI assigned
Jun 15, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2008

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

Authorized official

Name
George C Ego-Osuala, MD., FACP.NPI 1679578835
Title
President
Phone
(301) 434-9147

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X D 47156 MD Primary
Primary Care Clinic/Center 261QP2300X MD 21355 DC

Addresses

Primary practice location

5305 Kenilworth Ave
Ste 100
Riverdale, MD 20737-3110

Mailing address

PO Box 7909
Langley Park, MD 20787-7909

Other identifiers 2

IdentifierTypeStateIssuer
G02849OtherMDMEDICARE GROUP PTAN
852000300MedicaidMD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080625000747 DC Part B Supplier - Clinic/Group Practice 3678644267 Receives reassigned benefits from 1 practitioner
Practice locations: Lanham, MD

National Provider Directory

National Provider Directory

Locations

7411 Riggs Rd
Ste 428
Hyattsville, MD 20783
Phone (301) 408-0350

5305 Kenilworth Ave
Ste 100
Riverdale, MD 20737
Phone (301) 277-7110

5305 Kenilworth Ave
Riverdale Park, MD 20737
Phone (301) 277-7110

Practitioners & affiliated clinicians

Practitioners 6

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": "1118793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215648000000",
    "number": "1447255609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7909",
            "city": "LANGLEY PARK",
            "state": "MD",
            "postal_code": "207877909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5305 KENILWORTH AVE",
            "address_2": "STE 100",
            "city": "RIVERDALE",
            "state": "MD",
            "postal_code": "207373110",
            "telephone_number": "301-277-7110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGE MEDICAL CARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-15",
        "last_updated": "2008-07-10",
        "status": "A",
        "authorized_official_last_name": "EGO-OSUALA",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "301-434-9147",
        "authorized_official_credential": "MD., FACP."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MD",
            "license": "D 47156",
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "DC",
            "license": "MD 21355",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "G02849",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "852000300",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverdale, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.