Individual provider Active NPI

Edward J Lose, MD

Clinical Genetics (M.D.) Physician
Birmingham, AL

National Provider Identifier

1497786958

Registry record updated Feb 23, 2021

On this page

Key facts
NPPES NPI Registry
Medicare participation
National Provider Directory
Organizations & group practices2
NPI Registry JSON
Other providers in Birmingham, AL
Sources for this page

Key facts

NPPES NPI Registry

Primary specialty: Clinical Genetics (M.D.) PhysicianTaxonomy code 207SG0201X
License: 17705 Issued in AL
Practice address: 1600 7TH Ave S
Birmingham, AL 35233-1711
Phone: (205) 638-9100
NPI assigned: Jul 5, 2006
Sex: Male
Sole proprietor: No

NPPES NPI Registry

Updated by the provider on Feb 23, 2021

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

Specialties & licenses 4

Specialty (taxonomy)	Code	License	State	Primary
Emergency Medicine Physician	207P00000X	MD.17705	AL
Pediatrics Physician	208000000X	MD.17705	AL
Pediatric Emergency Medicine (Pediatrics) Physician	2080P0204X	MD.17705	AL
Clinical Genetics (M.D.) Physician	207SG0201X	17705	AL	Primary

Addresses

Primary practice location

1600 7TH Ave S
Birmingham, AL 35233-1711

Mailing address

1600 7TH Ave S
Birmingham, AL 35233-1711
Phone (205) 638-9587

Other practice location 1

619 19th Street South
Birmingham, AL 35233
Phone (205) 934-6600

Other identifiers 36

Identifier	Type	State	Issuer
009935375	Medicaid	AL
051020867	Other	AL	BLUE CROSS
051535390	Other	AL	BLUE CROSS
9938841	Medicaid	AL
009938834	Medicaid	AL
009953715	Medicaid	AL
051535484	Other	AL	BLUE CROSS
051535501	Other	AL	BLUE CROSS
051535504	Other	AL	BLUE CROSS
125385	Medicaid	AL
148176	Medicaid	AL
051535486	Other	AL	BLUE CROSS
051535668	Other	AL	BLUE CROSS
09922541	Medicaid	MS
009938844	Medicaid	AL
051520541	Other	AL	BLUE CROSS
051547020	Other	AL	BLUE CROSS
105120	Medicaid	AL
511-30868	Other	AL	BCBS
9938838	Medicaid	AL
051113380	Other	AL	BLUE CROSS
051590996	Other	AL	BLUE CROSS
105106	Medicaid	AL
051535507	Other	AL	BLUE CROSS
051535671	Other	AL	BLUE CROSS
051594923	Other	AL	BLUE CROSS
009938832	Medicaid	AL
009938833	Medicaid	AL
051106841	Other	AL	BLUE CROSS
009938839	Medicaid	AL
009938842	Medicaid	AL
009938843	Medicaid	AL
051535487	Other	AL	BLUE CROSS
051543551	Other	AL	BLUE CROSS
142698	Medicaid	AL
511-36079	Other	AL	BCBS

Medicare participation

Medicare enrollment files

Medicare fee-for-service enrollment

Enrolled in AL

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 1

Enrollment ID	State	Provider type	PAC ID	Details
I20040814000165	AL	Practitioner - Emergency MedicinePractitioner - Pediatric Medicine	3779556105	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Enrolled
Credentials: Doctor of Medicine

State licenses

License	State	Type	Specialty
MD.17705	AL	MD	Emergency Medicine Physician
17705	AL	MD	Clinical Genetics (M.D.) Physician

Practice roles

Organization	Specialty	Status	New patients
University of Alabama Health Services Foundation, PC.		CurrentSince Apr 1, 2004	Accepting new patients
University of Alabama Health Services Foundation, PC	Pediatrics	CurrentSince Apr 1, 2004	Accepting new patients

Locations

1600 7th Ave S
Birmingham, AL 35233
Phone (205) 638-9100

703 Volker Hall
Birmingham, AL 35294
Phone (205) 638-9587

619 19th St S
Birmingham, AL 35249

619 19th St S
Birmingham, AL 35233
Phone (205) 934-6405

Networks

bcbs alabama network 01H0
bcbs alabama network 01E0
bcbs alabama network 01G0
bcbs alabama network 01A0
bcbs alabama network 01I0
bcbs alabama network 01B0

Interoperability endpoints

Direct secure messaging: elose21004@childrensofalabama.direct-ci.com

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.

University of Alabama Health Services Foundation, PC.
- Multi-Specialty Clinic/Center
- Birmingham, AL
- NPI 1093768723
Medicare reassignment NPD
University of Alabama Health Services Foundation, PC
- Pediatrics Physician
- Birmingham, AL
- NPI 1356377576
NPD

NPI Registry JSON

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614038400000",
    "number": "1497786958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 7TH AVE S",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352331711",
            "telephone_number": "205-638-9587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 7TH AVE S",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352331711",
            "telephone_number": "205-638-9100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "619 19th Street South",
            "address_purpose": "LOCATION",
            "city": "Birmingham",
            "state": "AL",
            "postal_code": "35233",
            "country_code": "US",
            "telephone_number": "205-934-6600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LOSE",
        "first_name": "EDWARD",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-05",
        "last_updated": "2021-02-23",
        "certification_date": "2021-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AL",
            "license": "MD.17705",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AL",
            "license": "MD.17705",
            "primary": false
        },
        {
            "code": "2080P0204X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Emergency Medicine",
            "state": "AL",
            "license": "MD.17705",
            "primary": false
        },
        {
            "code": "207SG0201X",
            "taxonomy_group": "",
            "desc": "Medical Genetics, Clinical Genetics (M.D.)",
            "state": "AL",
            "license": "17705",
            "primary": true
        }
    ],
    "identifiers": [
        {
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        },
        {
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            "desc": "Other (non-Medicare)",
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        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "051535390",
            "state": "AL"
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        {
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            "identifier": "9938841",
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        },
        {
            "code": "05",
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            "identifier": "009938834",
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        },
        {
            "code": "05",
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            "identifier": "009953715",
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        },
        {
            "code": "01",
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            "issuer": "BLUE CROSS",
            "identifier": "051535484",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "051535501",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "051535504",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "125385",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "148176",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "051535486",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "051535668",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09922541",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009938844",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "051520541",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "051547020",
            "state": "AL"
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        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "105120",
            "state": "AL"
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        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "511-30868",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9938838",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "051113380",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "051590996",
            "state": "AL"
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        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
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            "state": "AL"
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        {
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            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "051535507",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "051535671",
            "state": "AL"
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        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "051594923",
            "state": "AL"
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        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009938832",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009938833",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "051106841",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009938839",
            "state": "AL"
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        {
            "code": "05",
            "desc": "MEDICAID",
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            "identifier": "009938842",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009938843",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "051535487",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "051543551",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "142698",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "511-36079",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Birmingham, AL

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2021; 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.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.