Edgar A D Mendoza, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

33465 Issued in KY

Practice address

1484 Lakeside Drive
Jackson, KY 41339-6555

Phone

(606) 666-9950

Fax

(606) 666-9136

NPI assigned

Sep 15, 2006

Last updated

Mar 13, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in KY

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: edgarmendoza@juniperhea.allscriptsdirect.net

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

• Juniper Health Inc

  dba Lee County Family Medical Clinic

  • Federally Qualified Health Center (FQHC)
  • Beattyville, KY
  • NPI 1407818628
  NPD (past)
• Juniper Health Inc

  dba Breathitt County Family Health Center

  • Federally Qualified Health Center (FQHC)
  • Jackson, KY
  • NPI 1467417691
  NPD (past)

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

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584057600000",
    "number": "1891891388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 690",
            "city": "BEATTYVILLE",
            "state": "KY",
            "postal_code": "413110690",
            "telephone_number": "606-464-0151",
            "fax_number": "606-464-0152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1484 LAKESIDE DRIVE",
            "city": "JACKSON",
            "state": "KY",
            "postal_code": "413396555",
            "telephone_number": "606-666-9950",
            "fax_number": "606-666-9136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENDOZA",
        "first_name": "EDGAR",
        "middle_name": "A D",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-15",
        "last_updated": "2020-03-13",
        "certification_date": "2020-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "KY",
            "license": "33465",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64343650",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID FQHC GROUP",
            "identifier": "1467417691",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anna Mayes
• McIntosh Ambulance Inc (McIntosh Empire Inc)
• Adam McIntosh, APRN FNP-BC
• Kelly Ann McIntosh, PHARMD
• Aloysius Francis Meives IV
• Pablo Alabanza Merced, M.D.
• Peter Anthony Merced
• Mercy Clinic of Jackson, PLLC
• Crystal Dawn Meyer, MSN, APRN, FNP-C
• Robert Scott Moore, PHARMD

• Pediatrics Physician in Jackson, KY
• Providers in Jackson, KY by specialty
• Pediatrics Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.