Active NPI
Phillip L. Edwardson, M.D.
- Child & Adolescent Psychiatry Physician
- Minneapolis, MN
National Provider Identifier
1891862389
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child & Adolescent Psychiatry Physician
- License
- 19329
- Practice address
- 3100 W Lake St
Suite 210
Minneapolis, MN 55416-4527 - Phone
- (612) 925-6033
- NPI assigned
- Nov 29, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Child & Adolescent Psychiatry Physician | 2084P0804X | 19329 | MN | Primary |
Addresses
Primary practice location
3100 W Lake St
Suite 210
Minneapolis, MN 55416-4527
Mailing address
3100 W Lake St
Suite 210
Minneapolis, MN 55416-4527
Phone (612) 925-6033
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 830593500 | Other | MN | MEDICAL ASSISTANCE |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1387497600000",
"number": "1891862389",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3100 W LAKE ST",
"address_2": "SUITE 210",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554164527",
"telephone_number": "612-925-6033"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3100 W LAKE ST",
"address_2": "SUITE 210",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554164527",
"telephone_number": "612-925-6033"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDWARDSON",
"first_name": "PHILLIP",
"middle_name": "L.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-29",
"last_updated": "2013-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "MN",
"license": "19329",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL ASSISTANCE",
"identifier": "830593500",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Minneapolis, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 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.