Edwin Rader, MD
Individual provider Active NPI Family Medicine Physician · Thomas, WV
NPI 1821082801 · NPPES record last updated Mar 28, 2013
Key facts
- NPI
- 1821082801
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 15058 (WV)
- Practice address
- 30 Cortland Acres Lane
Thomas, WV 26292-9704 - Phone
- (304) 463-3331
- Fax
- (304) 463-3338
- NPI assigned
- Sep 7, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Owned or controlled facilities with NPI records 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WV
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Mt Storm Health Center |
Federally qualified health center | Corporate Director | May 25, 2026 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040227000197 | WV | Practitioner - Family Practice | 3476449273 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15058 | WV | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Specialty Physicians of Garrett County, LLC | Current | Accepting new patients | |
| Cortland Acres Association Inc. | Current |
Accepting new patients |
Locations
39 Cortland Acres Ln
Thomas, WV 26292
Phone (304) 463-4181
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 15058 | WV | Yes |
Addresses
Primary practice location
30 Cortland Acres Lane
Thomas, WV 26292-9704
Mailing address
PO Box 35
Newburg, WV 26410-0035
Phone (304) 892-2828
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0052162000 | Medicaid | WV |
Other providers in Thomas, WV
- Shelby Moore
- Herbert E Myers
- Preston Taylor Community Health Centers, Incorporated
- Preston Taylor Community Health Centers, Incorporated
- Preston-Taylor Community Health Centers Incorporated
- Katherine Russell
- Shirley Simmons
- Melinda D Stoner
- Jennifer Walker
- Sarah Walters
All providers in Thomas, WV · Family Medicine Physician in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 28, 2013. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.