Adria L Edenfield II, PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

PA3480 Issued in FL

Practice address

11701-32 San Jose Blvd #103
Jacksonville, FL 32223

Phone

(904) 940-1441

NPI assigned

Jun 15, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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.

• Fountain Family Medicine, PA

  • Family Medicine Physician
  • Jacksonville, FL
  • NPI 1124228119
  NPD

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1386806400000",
    "number": "1629012182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11701-32 SAN JOSE BLVD #103",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32223",
            "telephone_number": "904-940-1441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11701-32 SAN JOSE BLVD #103",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32223",
            "telephone_number": "904-940-1441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDENFIELD",
        "first_name": "ADRIA",
        "middle_name": "L",
        "name_suffix": "II",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-15",
        "last_updated": "2013-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "PA3480",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "292259200",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "970009777",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sumanth Kumar Edara, RPH
• Destiny Rae Eddards
• Connie Edelen, MD
• Hannah Devore Edelstein
• Erica Kendra Eden, DDS
• David Edenfield, D.C.
• Jonathan Edenfield, M.S. OTR/L
• Kristen Edenfield
• Victoria Edenfield, ARNP
• Diana L Edgar, M.D.

• Family Medicine Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2013; 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.