Active NPI
Philip Ellis Freedman, MD
- Family Medicine Physician
- Edwards, CO
National Provider Identifier
1790757284
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 19624
- Practice address
- 141 Snaffle Rd.
Edwards, CO 81632-2294 - Phone
- (970) 926-0314
- Fax
- (970) 926-3214
- NPI assigned
- Feb 7, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 19624 | CO | Primary |
Addresses
Primary practice location
141 Snaffle Rd.
Edwards, CO 81632-2294
Mailing address
PO Box 2294
Edwards, CO 81632-2294
Phone (970) 926-0314
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01196245 | Medicaid | CO |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 19624 | CO | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139270400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1384473600000",
"number": "1790757284",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2294",
"city": "EDWARDS",
"state": "CO",
"postal_code": "816322294",
"telephone_number": "970-926-0314",
"fax_number": "970-926-3214"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "141 SNAFFLE RD.",
"city": "EDWARDS",
"state": "CO",
"postal_code": "816322294",
"telephone_number": "970-926-0314",
"fax_number": "970-926-3214"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FREEDMAN",
"first_name": "PHILIP",
"middle_name": "ELLIS",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-02-07",
"last_updated": "2013-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "CO",
"license": "19624",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01196245",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Edwards, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.