Active NPI
Lida Lacy Edmundson, MD
- Psychiatry Physician
- Dallas, TX
National Provider Identifier
1710190889
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- D3210
- Practice address
- 12700 Hillcrest Rd
Suite 260
Dallas, TX 75230-2033 - Phone
- (972) 789-9319
- Fax
- (972) 789-9324
- NPI assigned
- May 7, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | D3210 | TX | Primary |
Addresses
Primary practice location
12700 Hillcrest Rd
Suite 260
Dallas, TX 75230-2033
Mailing address
12700 Hillcrest Rd
Suite 260
Dallas, TX 75230-2033
Phone (972) 789-9319
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective May 20, 2019 through May 20, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D3210 | TX | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1710190889",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12700 HILLCREST RD",
"address_2": "SUITE 260",
"city": "DALLAS",
"state": "TX",
"postal_code": "752302033",
"telephone_number": "972-789-9319",
"fax_number": "972-789-9324"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12700 HILLCREST RD",
"address_2": "SUITE 260",
"city": "DALLAS",
"state": "TX",
"postal_code": "752302033",
"telephone_number": "972-789-9319",
"fax_number": "972-789-9324"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDMUNDSON",
"first_name": "LIDA",
"middle_name": "LACY",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "TX",
"license": "D3210",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- 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; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.