NPIMap

Organization Active NPI

Edge Counseling and Wellness LLC

  • Clinical Social Worker
  • Peoria, IL
National Provider Identifier
1790275485
Registry record updated Nov 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
Legal business name
EDGE COUNSELING AND WELLNESS LLC
Practice address
719 W Lake Ave
Peoria, IL 61614-5941
Phone
(309) 360-8912
NPI assigned
May 17, 2018
Last updated
Nov 7, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2021

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

Authorized official

Name
Audrey Lemasters, LCSWNPI 1811058753
Title
Owner
Phone
(309) 360-8912

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X NU Primary

Addresses

Primary practice location

719 W Lake Ave
Peoria, IL 61614-5941

Mailing address

719 W Lake Ave
Peoria, IL 61614-5941
Phone (309) 360-8912

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180731002045 IL Part B Supplier - Clinic/Group Practice 1951659465 Receives reassigned benefits from 11 practitioners
Practice locations: Peoria, IL

National Provider Directory

National Provider Directory

Locations

5101 N Executive Dr
Peoria, IL 61614
Phone (309) 408-1493

719 W Lake Ave
Peoria, IL 61614
Phone (309) 408-1493

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1526515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1636243200000",
    "number": "1790275485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "719 W LAKE AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616145941",
            "telephone_number": "309-360-8912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "719 W LAKE AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616145941",
            "telephone_number": "309-360-8912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGE COUNSELING AND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-17",
        "last_updated": "2021-11-07",
        "certification_date": "2021-11-07",
        "status": "A",
        "authorized_official_last_name": "LEMASTERS",
        "authorized_official_first_name": "AUDREY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "309-360-8912",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.