Individual provider Active NPI

Randall Scott Edwards, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • Evansville, IN
National Provider Identifier
1871751644
Registry record updated Oct 16, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
12011270A Issued in IN
Practice address
550 W Virginia St
Evansville, IN 47710-1614
Phone
(812) 425-5194
Fax
(812) 426-9984
NPI assigned
May 29, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X 12011270A IN Primary

Addresses

Primary practice location

550 W Virginia St
Evansville, IN 47710-1614

Mailing address

550 W Virginia St
Evansville, IN 47710-1614
Phone (812) 425-5194

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091205000093 IN Practitioner - Oral SurgeryPractitioner - Maxillofacial Surgery 7416096359 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Oral SurgeryAlso: Maxillofacial Surgery
Education
Indiana University School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Oral Surgery Group of Evansville IncGroup PAC ID 5991880106, 5 clinicians

Practice addresses (Care Compare)

550 W Virginia St
Evansville, IN 47710-1614
Phone (812) 425-5194

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Oral Surgery Group of Evansville, Inc Oral and Maxillofacial Surgery CurrentSince Oct 25, 2009 Accepting new patients

Locations

550 W Virginia St
Evansville, IN 47710
Phone (812) 425-5194

Organizations & group practices 1

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1212019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1255651200000",
    "number": "1871751644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 W VIRGINIA ST",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477101614",
            "telephone_number": "812-425-5194",
            "fax_number": "812-426-9984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 W VIRGINIA ST",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477101614",
            "telephone_number": "812-425-5194",
            "fax_number": "812-426-9984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDWARDS",
        "first_name": "RANDALL",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-29",
        "last_updated": "2009-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IN",
            "license": "12011270A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evansville, IN

Sources for this page

Verify at the official NPI Registry.