Active NPI
Timothy Dwight Edmisten, MD
- Surgery Physician
- Boone, NC
National Provider Identifier
1780679357
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 9800856
- Practice address
- 965 State Farm Rd
Boone, NC 28607-4948 - Phone
- (828) 264-2340
- Fax
- (828) 262-0731
- NPI assigned
- Sep 20, 2005
- Last updated
- Mar 10, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 9800856 | NC | Primary |
| Vascular Surgery Physician | 2086S0129X | 9800856 | NC | |
| Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | 208G00000X | 9800856 | NC |
Addresses
Primary practice location
965 State Farm Rd
Boone, NC 28607-4948
Mailing address
965 State Farm Rd
Boone, NC 28607-4948
Phone (828) 264-2340
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 891227R | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- General Surgery
- Education
- Brody School of Medicine at East Carolina University, 1993
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
965 State Farm Rd
Boone, NC 28607-4948
Phone (828) 264-2340
Hospital & facility affiliations
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Colonoscopy | 17 |
| Hernia repair - groin (open) | 1-10 |
| Upper gastrointestinal (GI) endoscopy for acid reflux | 21 |
| Melanoma (skin cancer) excision | 1-10 |
| Removal of nail tissue | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Appalachian Regional Medical Associates, Inc. | Surgery | Current | Accepting new patients |
Locations
211 Milton Brown Heirs Rd
Boone, NC 28607
Phone (828) 264-6720
336 Deerfield Rd
Boone, NC 28607
Phone (828) 263-1211
965 State Farm Rd
Boone, NC 28607
Phone (704) 264-2340
Interoperability endpoints
- tedmisten201306@direct.unc.nchie.net
- timedmisten@arhs.allscriptsdirect.net
Organizations & group practices 1
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.
-
dba Appalachian Gastroenterology
- Family Medicine Physician
- Boone, NC
- NPI 1669533923
Surgery
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Cannon Inpatient Behavioral Health
- Psychiatric Hospital Unit
- Linville, NC
- NPI 1407006968
-
dba Appalachian Regional Healthcare System
- Critical Access Hospital
- Linville, NC
- NPI 1225088255
-
dba Watauga Medical Center
- General Acute Care Hospital
- Boone, NC
- NPI 1205859766
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127174400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678406400000",
"number": "1780679357",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "965 STATE FARM RD",
"city": "BOONE",
"state": "NC",
"postal_code": "286074948",
"telephone_number": "828-264-2340",
"fax_number": "828-262-0731"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "965 STATE FARM RD",
"city": "BOONE",
"state": "NC",
"postal_code": "286074948",
"telephone_number": "828-264-2340",
"fax_number": "828-262-0731"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDMISTEN",
"first_name": "TIMOTHY",
"middle_name": "DWIGHT",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-09-20",
"last_updated": "2023-03-10",
"certification_date": "2023-03-10",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "NC",
"license": "9800856",
"primary": true
},
{
"code": "2086S0129X",
"taxonomy_group": "",
"desc": "Surgery, Vascular Surgery",
"state": "NC",
"license": "9800856",
"primary": false
},
{
"code": "208G00000X",
"taxonomy_group": "",
"desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
"state": "NC",
"license": "9800856",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "891227R",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boone, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2023; 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.