Individual provider Active NPI

Courtney Lynne Edwards, PA-C

  • Physician Assistant
  • Denver, CO
National Provider Identifier
1447669460
Registry record updated Oct 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.0004036 Issued in CO
Practice address
1721 E 19TH Ave Ste 300
Denver, CO 80218-1258
Phone
(720) 754-4800
Fax
(720) 754-4801
NPI assigned
Aug 4, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA.0004036 CO Primary

Addresses

Primary practice location

1721 E 19TH Ave Ste 300
Denver, CO 80218-1258

Mailing address

1721 E. 19TH Ave.
Suite 200
Denver, CO 80218
Phone (720) 754-4800

Other identifiers 1

IdentifierTypeStateIssuer
36428876MedicaidCO

Other names 1

  • Courtney Lynne Bryan Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140829002083 CO Practitioner - Physician Assistant 8628296811 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Healthone Clinic Services - Oncology Hematology LLCGroup PAC ID 9436293461, 47 clinicians

Practice addresses (Care Compare)

1719 E 19TH Ave
Presbyterian St Lukes Medical Center
Denver, CO 80218-1235
Phone (303) 839-6000

1721 E 19TH Ave
Suite 300
Denver, CO 80218-1251
Phone (720) 754-4800

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Intermountain Medical Group Denver, LLC CurrentSince Nov 29, 2021 Accepting new patients
Intermountain Medical Group Denver, LLC CurrentSince Nov 29, 2021 Accepting new patients
Alton-Griffin Emergency Group PC Physician Assistant Past Accepting new patients

Locations

4859 Yampa St
Denver, CO 80249
Phone (303) 498-1885

Organizations & group practices 5

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.

Hospital & facility affiliations 1

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": "1407110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571616000000",
    "number": "1447669460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1721 E. 19TH AVE.",
            "address_2": "SUITE 200",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "80218",
            "telephone_number": "720-754-4800",
            "fax_number": "720-754-4801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1721 E 19TH AVE STE 300",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802181258",
            "telephone_number": "720-754-4800",
            "fax_number": "720-754-4801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "COURTNEY",
        "middle_name": "LYNNE",
        "name_prefix": "Mrs.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-08-04",
        "last_updated": "2019-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0004036",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36428876",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "COURTNEY",
            "last_name": "BRYAN",
            "middle_name": "LYNNE",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Denver, CO

Sources for this page

Verify at the official NPI Registry.