Charles J. Edelen, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

30017977 Issued in OH

Practice address

425 W Russell Rd
Sidney, OH 45365-1454

Phone

(937) 492-2848

Fax

(937) 492-8615

NPI assigned

Jan 23, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

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 1

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Shelby County Memorial Hospital Association Inc.

  dba Wilson Memorial Hospital

  • Community Based Hospice Care Agency
  • Sidney, OH
  • NPI 1376531533

  Corporate Director

  CMS ownership

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.

• Charles J. Edelen, D.D.S., Inc.

  dba Midwest Ohio Dental Care

  • General Practice Dentistry
  • Sidney, OH
  • NPI 1770757478
  NPD (past) Authorized official

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

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1639223712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 W RUSSELL RD",
            "city": "SIDNEY",
            "state": "OH",
            "postal_code": "453651454",
            "telephone_number": "937-492-2848",
            "fax_number": "937-492-8615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 W RUSSELL RD",
            "city": "SIDNEY",
            "state": "OH",
            "postal_code": "453651454",
            "telephone_number": "937-492-2848",
            "fax_number": "937-492-8615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDELEN",
        "first_name": "CHARLES",
        "middle_name": "J.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30017977",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0829170",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Honey Gem Drinnen
• Amanda Maria Dues
• Catherine Dulin
• Alexis Nicole Dunn
• Sonya Eaton
• Jason Daniel Edwards
• Stacie Edwards
• Theresa Kay Edwards, APRN-CNP
• Joy Renee Egbert
• Julie L Ehemann, RPH

• General Practice Dentistry in Sidney, OH
• Providers in Sidney, OH by specialty
• General Practice Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.