Individual provider Active NPI

Edward H Andres III, M.D.

  • Surgery Physician
  • Saint Joseph, MO
National Provider Identifier
1639102460
Registry record updated Feb 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
R4278 Issued in MO
Practice address
802 N. Riverside Rd.,
Suite G 50
Saint Joseph, MO 64507-2553
Phone
(816) 671-4888
Fax
(816) 671-4890
NPI assigned
Jul 7, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2011

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X R4278 MO Primary
Trauma Surgery Physician 2086S0127X R4278 MO
Vascular Surgery Physician 2086S0129X R4278 MO

Addresses

Primary practice location

802 N. Riverside Rd.,
Suite G 50
Saint Joseph, MO 64507-2553

Mailing address

802 N. Riverside Rd.,
Suite G 50
Saint Joseph, MO 64507-2553
Phone (816) 671-4888

Other identifiers 4

IdentifierTypeStateIssuer
10001262101OtherMOCOMMUNITY HEALTH PLAN
100130870BMedicaidKS
P00193414OtherMORR MEDICARE
200374411MedicaidMO

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)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
R4278MOMDVascular Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Heartland Regional Medical Center Past Accepting new patients
Heartland Regional Medical Center Past Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1298851200000",
    "number": "1639102460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "802 N. RIVERSIDE RD.,",
            "address_2": "SUITE G 50",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645072553",
            "telephone_number": "816-671-4888",
            "fax_number": "816-671-4890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "802 N. RIVERSIDE RD.,",
            "address_2": "SUITE G 50",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645072553",
            "telephone_number": "816-671-4888",
            "fax_number": "816-671-4890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDRES",
        "first_name": "EDWARD",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-07",
        "last_updated": "2011-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MO",
            "license": "R4278",
            "primary": true
        },
        {
            "code": "2086S0127X",
            "taxonomy_group": "",
            "desc": "Surgery, Trauma Surgery",
            "state": "MO",
            "license": "R4278",
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "MO",
            "license": "R4278",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMUNITY HEALTH PLAN",
            "identifier": "10001262101",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100130870B",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00193414",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200374411",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Joseph, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2011; 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.