Chad P Edwards, D.O.
Individual provider Active NPI Family Medicine Physician · Glenpool, OK
NPI 1790833481 · NPPES record last updated Nov 8, 2022
Key facts
- NPI
- 1790833481
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 4353 (OK)
- Practice address
- 12142 S Yukon Ave
Glenpool, OK 74033 - Phone
- (918) 935-3636
- Fax
- (918) 296-7934
- NPI assigned
- Jan 8, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2004
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Transformation Health PLLC
Practice addresses (Care Compare)
1008 W Taft Ave
Sapulpa, OK 74066-8720
Phone (918) 935-3636
Hospital & facility affiliations
- Saint Francis Hospital, Inc
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111103000926 | OK | Practitioner - Family Practice |
5991883621 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1920 | TN | MD | Occupational Therapy Assistant |
| 4353 | OK | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Emergency Physicians of Hopkinsville PLLC | Emergency Medicine | Past | Accepting new patients |
| Caleb Creek Emergency Physicians, PLLC | Emergency Medicine | Past | Accepting new patients |
| Decatur County General Hospital | Past | Accepting new patients | |
| Bolivar General Hospital, Inc. | Past | Accepting new patients | |
| Summit Medical Center | Past | Accepting new patients | |
| Bolivar General Hospital, Inc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 03124 | KY | |
| Family Medicine Physician | 207Q00000X | 4353 | OK | Yes |
Addresses
Primary practice location
12142 S Yukon Ave
Glenpool, OK 74033
Mailing address
12142 S Yukon Ave
Glenpool, OK 74033-6621
Phone (918) 935-3636
Other providers in Glenpool, OK
- Donna J. Price, D.O. P.C.
- Brooke Lynn Dooley
- Drayer Physical Therapy Oklahoma LLC
- Colton Douglas Dunlap
- Eclipse Smiles, PLLC
- Emergency Medical Services Plus, LLC
- Monica Lynn Englehart
- David Ewing
- Eyecare Associates of South Tulsa PC
- Miki Lynn Finnin
All providers in Glenpool, OK · Family Medicine Physician in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 8, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.