Edward Andrew Fazendin, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

38369 Issued in AL

Practice address

3686 Grandview Pkwy Ste 400
Birmingham, AL 35243-3404

Phone

(205) 595-8985

Fax

(205) 595-8987

NPI assigned

Jun 13, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in SD, TN, OK3 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 3

Specialty

General Surgery

Education

Medical College of Wisconsin, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Farmers Union Hospital AssociationGroup PAC ID 7517949415, 43 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Great Plains Regional Medical Center Hospital, Elk City, OK, CCN 370019

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: edward.fazendin.1@19363.direct.athenahealth.com

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.

• Farmers Union Hospital Association

  • General Acute Care Hospital
  • Elk City, OK
  • NPI 1184639122
  Medicare reassignment Care Compare group NPD
• Amg-Southern Tennessee LLC

  • General Practice Physician
  • Winchester, TN
  • NPI 1164789467
  Medicare reassignment NPD
• Amg-Southern Tennessee LLC

  • Rural Health Clinic/Center
  • Tullahoma, TN
  • NPI 1174365803
  NPD
• Farmers Union Hospital Association

  • Rural Health Clinic/Center
  • Elk City, OK
  • NPI 1114421492
  NPD
• Columbia Lutheran Charities

  • Community Based Hospice Care Agency
  • Astoria, OR
  • NPI 1023038858
  NPD (past)
• Columbia Lutheran Charities

  • Critical Access Hospital
  • Astoria, OR
  • NPI 1932814704
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Farmers Union Hospital Association

  • Rural Health Clinic/Center
  • Elk City, OK
  • NPI 1023512308

  Hospital

  Care Compare affiliation
• Farmers Union Hospital Association

  • Rural Health Clinic/Center
  • Elk City, OK
  • NPI 1114421492

  Hospital

  Care Compare affiliation
• Farmers Union Hospital Association

  • General Acute Care Hospital
  • Elk City, OK
  • NPI 1184639122
  Care Compare affiliation

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

{
    "created_epoch": "1371081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672790400000",
    "number": "1487092391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3686 GRANDVIEW PKWY STE 400",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352433404",
            "telephone_number": "205-595-8985",
            "fax_number": "205-595-8987"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3686 GRANDVIEW PKWY STE 400",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352433404",
            "telephone_number": "205-595-8985",
            "fax_number": "205-595-8987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAZENDIN",
        "first_name": "EDWARD",
        "middle_name": "ANDREW",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-13",
        "last_updated": "2023-01-04",
        "certification_date": "2023-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "PA",
            "license": "MT204318",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "AL",
            "license": "38369",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "256202",
            "state": "AL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "edward-fazendin@advancedsurgeonspc.e-mdsdirect.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "3686 Grandview Pkwy Ste 400",
            "city": "Birmingham",
            "state": "AL",
            "country_code": "US",
            "postal_code": "352433404",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "efazendin2665650@wm.providencedirect.org",
            "affiliation": "N",
            "address_1": "600 Mt Highway 91 S",
            "city": "Dillon",
            "state": "MT",
            "country_code": "US",
            "postal_code": "597257379",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jeanne Favrot, M. D.
• Stephen R Favrot, MD
• Ona M Faye-Peterson, MD
• Boris Faynberg
• Aalia Fayyaz
• Alicia Fazzaro, MD
• FC of Alabama Inc
• Chase Allen Feagin, DMD
• R Wyatt Feagin II, M.D.
• John Phillip Featheringill, MD

• Surgery Physician in Birmingham, AL
• Providers in Birmingham, AL by specialty
• Surgery Physician in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.