NPIMap

Individual provider Active NPI

Lee Wichner Edelstein, MD

  • Pediatrics Physician
  • Lake Wales, FL
National Provider Identifier
1629056536
Registry record updated Sep 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
ME75376 Issued in FL
Practice address
305 W Central Ave
Lake Wales, FL 33853-4015
Phone
(866) 234-8534
NPI assigned
Jan 3, 2006
Last updated
Sep 14, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 14, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X ME75376 FL Primary

Addresses

Primary practice location

305 W Central Ave
Lake Wales, FL 33853-4015

Mailing address

47 5TH St NW
Winter Haven, FL 33881-4672
Phone (866) 234-8534

Other identifiers 1

IdentifierTypeStateIssuer
254527600MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
ME75376FLMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central Florida Health Care, Inc. Past Accepting new patients
Central Florida Health Care, Inc. Past Accepting new patients
Central Florida Health Care, Inc. Past Accepting new patients
Central Florida Health Care, Inc Past Accepting new patients
Central Florida Health Care Inc Past Accepting new patients
Central Florida Health Care, Inc. Past Accepting new patients
Central Florida Health Care, Inc. Past Accepting new patients
Central Florida Health Care Inc Past Accepting new patients
Central Florida Health Care, Inc Past Accepting new patients
Vitalmd Group Holding LLC Pediatrics Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: lee.edelstein.1@12125.direct.athenahealth.com

Organizations & group practices 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1136246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663113600000",
    "number": "1629056536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47 5TH ST NW",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338814672",
            "telephone_number": "866-234-8534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 W CENTRAL AVE",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338534015",
            "telephone_number": "866-234-8534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDELSTEIN",
        "first_name": "LEE",
        "middle_name": "WICHNER",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-03",
        "last_updated": "2022-09-14",
        "certification_date": "2022-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME75376",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "254527600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Wales, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.