Individual provider Active NPI

Kristen Edenfield

  • Audiologist
  • Jacksonville, FL
National Provider Identifier
1821479650
Registry record updated Jan 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
AY1940 Issued in FL
Practice address
10475 Centurion Pkwy N
#303
Jacksonville, FL 32256-5003
Phone
(904) 399-0350
Fax
(904) 399-5914
NPI assigned
Jun 17, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X AY1940 FL Primary

Addresses

Primary practice location

10475 Centurion Pkwy N
#303
Jacksonville, FL 32256-5003

Mailing address

11945 San Jose Blvd
#300
Jacksonville, FL 32223-1613
Phone (904) 396-1725

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181115002019 TX Practitioner - Qualified Audiologist 5698088243 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Qualified Audiologist
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University of Texas Southwestern Medical Center at DallasGroup PAC ID 0648188250, 3,156 clinicians

Practice addresses (Care Compare)

2001 Inwood Rd
Dallas, TX 75390-7202
Phone (214) 645-2800

Merit-based Incentive Payment System (MIPS)

Final score
82.87 of 100Reported as group
Quality
70.15
Promoting interoperability
100
Improvement activities
40
Cost
72.75

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
AY1940FLMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
University of Texas Southwestern Medical Center at Dallas Current Accepting new patients
Dallas County Hospital District CurrentSince Dec 5, 2018 Accepting new patients
The University of Texas Southwestern Medical Center at Dallas CurrentSince Oct 8, 2018 Accepting new patients
University of Texas Southwestern Medical Center at Dallas CurrentSince Oct 8, 2018 Accepting new patients
Dallas County Hospital District Current Accepting new patients
Dallas County Hospital District CurrentSince Dec 5, 2018 Accepting new patients

Locations

3000 N Interstate 35
Denton, TX 76201
Phone (469) 303-3591

600 S Main St
Ft Worth, TX 76104
Phone (817) 882-2400

1800 N Britain Rd
Irving, TX 75061
Phone (214) 266-3000

420 E 6th St
Ste 202
Odessa, TX 79761
Phone (214) 648-9618

2001 Inwood Rd
Ut Southwest Medical Center, TX 75390
Phone (214) 645-8000

5303 Harry Hines Blvd
Ut Southwest Medical Center, TX 75390
Phone (214) 645-2300

5323 Harry Hines Blvd
Ut Southwest Medical Center, TX 75390

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1434499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1516060800000",
    "number": "1821479650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11945 SAN JOSE BLVD",
            "address_2": "#300",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322231613",
            "telephone_number": "904-396-1725",
            "fax_number": "904-399-1717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10475 CENTURION PKWY N",
            "address_2": "#303",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322565003",
            "telephone_number": "904-399-0350",
            "fax_number": "904-399-5914"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDENFIELD",
        "first_name": "KRISTEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-06-17",
        "last_updated": "2018-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "FL",
            "license": "AY1940",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.