Individual provider Active NPI

Edmund Thomas Carroll III, D.O.

Orthopaedic Surgery Physician
Lewes, DE

National Provider Identifier

1629029749

Registry record updated Jan 23, 2020

On this page

Key facts
NPPES NPI Registry
Medicare participation
Care Compare profile
National Provider Directory
Organizations & group practices7
NPI Registry JSON
Other providers in Lewes, DE
Sources for this page

Key facts

NPPES NPI Registry

Primary specialty: Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License: C20007511 Issued in DE
Practice address: 12100 Black Swan Drive
Suite 201
Lewes, DE 19958-4988
Phone: (302) 644-3311
Fax: (302) 644-3300
NPI assigned: May 13, 2006
Last updated: Jan 23, 2020By the provider in NPPES
Sex: Male
Sole proprietor: No

NPPES NPI Registry

Updated by the provider on Jan 23, 2020

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

Specialties & licenses 1

Specialty (taxonomy)	Code	License	State	Primary
Orthopaedic Surgery Physician	207X00000X	C20007511	DE	Primary

Addresses

Primary practice location

12100 Black Swan Drive
Suite 201
Lewes, DE 19958-4988

Mailing address

211 Executive Dr Ste 11
Newark, DE 19702-3358
Phone (302) 451-6913

Other practice location 1

17005 Old Orchard Rd
Lewes, DE 19958-4828
Phone (302) 644-3311

Other identifiers 15

Identifier	Type	State	Issuer
51-0343207	Other		BLUE CROSS BLUE SHIELD OF DELAWARE
51-0370286	Other		GREAT-WEST HEALTHCARE
204955	Other		UNISON HEALTH PLAN
2129304	Other		ONENET PPO, MAMSI, OPTIMUM CHOICE
51-0370286	Other		UNITED HEALTHCARE
1184681488	Other		COMMERCIAL INSURANCES
51-0370286	Other		HEALTH NET - TRICARE/CHAMPUS
3638665	Other		AETNA US HEALTHCARE
1000035330	Medicaid	DE
51-0370286	Other		UNION LABOR LIFE INSURANCE COMPANY
2356448000	Other		AMERIHEALTH
P00247768	Other		RAILROAD MEDICARE
51-0370286	Other		DEVON HEALTH SERVICES
51-0370286	Other		CIGNA
51-0370286	Other		CORVEL/CORCARE

Medicare participation

Medicare enrollment files

Medicare fee-for-service enrollment

Enrolled in DE

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
I20041227000628	DE	Practitioner - Orthopedic Surgery	0143280024

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score: 97.8 of 100Reported as group
Quality: 96
Promoting interoperability: 100
Improvement activities: 40

National Provider Directory

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

State licenses

License	State	Type	Specialty
C20007511	DE	MD	Orthopaedic Surgery Physician

Practice roles

Organization	Specialty	Status	New patients
Egnm LLC		Current	Accepting new patients
First State Orthopaedics, PA	Orthopaedic Surgery	Past	Accepting new patients
First State Orthopaedics, PA	Orthopaedic Surgery	Past	Accepting new patients
First State Orthopaedics, PA	Orthopaedic Surgery	Past	Accepting new patients
First State Orthopaedics, PA	Orthopaedic Surgery	Past	Accepting new patients
Jeremy Stern MD Inc.		PastSince Jun 1, 1999	Accepting new patients
David E. Adelberg MD Inc.	Orthopaedic Surgery	Past	Accepting new patients

Interoperability endpoints

Direct secure messaging: edmund.carroll.p2@direct.fsoortho.nextgenshare.com

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Egnm LLC

dba Lewes Surgery Center
- Ambulatory Surgical Clinic/Center
- Lewes, DE
- NPI 1275642480
NPD
First State Orthopaedics, PA

dba Orthopaedic Associates of Southern Delaware, PA
- Orthopaedic Surgery Physician
- Ocean View, DE
- NPI 1316501281
NPD (past)
First State Orthopaedics, PA
- Orthopaedic Surgery Physician
- Newark, DE
- NPI 1346220266
NPD (past)
First State Orthopaedics, PA
- Orthopaedic Surgery Physician
- Millsboro, DE
- NPI 1467228775
NPD (past)
First State Orthopaedics, PA

dba Orthopaedic Associates of Southern Delaware, PA
- Orthopaedic Surgery Physician
- Lewes, DE
- NPI 1619528775
NPD (past)
David E. Adelberg MD Inc.
- Orthopaedic Surgery Physician
- N Dartmouth, MA
- NPI 1750433579
NPD (past)
Jeremy Stern MD Inc.
- Sports Medicine (Orthopaedic Surgery) Physician
- N Dartmouth, MA
- NPI 1730160458
NPD (past)

NPI Registry JSON

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

{
    "created_epoch": "1147478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579737600000",
    "number": "1629029749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 EXECUTIVE DR STE 11",
            "city": "NEWARK",
            "state": "DE",
            "postal_code": "197023358",
            "telephone_number": "302-451-6913",
            "fax_number": "302-368-7756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12100 BLACK SWAN DRIVE",
            "address_2": "SUITE 201",
            "city": "LEWES",
            "state": "DE",
            "postal_code": "199584988",
            "telephone_number": "302-644-3311",
            "fax_number": "302-644-3300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17005 Old Orchard Rd",
            "address_purpose": "LOCATION",
            "city": "Lewes",
            "state": "DE",
            "postal_code": "199584828",
            "country_code": "US",
            "telephone_number": "302-644-3311",
            "fax_number": "302-644-3300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "EDMUND",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-13",
        "last_updated": "2020-01-23",
        "certification_date": "2020-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "DE",
            "license": "C20007511",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF DELAWARE",
            "identifier": "51-0343207",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GREAT-WEST  HEALTHCARE",
            "identifier": "51-0370286",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNISON HEALTH PLAN",
            "identifier": "204955",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ONENET PPO, MAMSI, OPTIMUM CHOICE",
            "identifier": "2129304",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "51-0370286",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMERCIAL INSURANCES",
            "identifier": "1184681488",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NET - TRICARE/CHAMPUS",
            "identifier": "51-0370286",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA US HEALTHCARE",
            "identifier": "3638665",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000035330",
            "state": "DE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNION LABOR LIFE INSURANCE COMPANY",
            "identifier": "51-0370286",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH",
            "identifier": "2356448000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00247768",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEVON HEALTH SERVICES",
            "identifier": "51-0370286",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "51-0370286",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CORVEL/CORCARE",
            "identifier": "51-0370286",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lewes, DE

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2020; 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.