Edward Lee Pearson, NURSE PRACTITIONER

Primary specialty

Adult Medicine PhysicianTaxonomy code 207QA0505X

License

4704206310 Issued in MI

Practice address

320 Hubbard St
Saint Louis, MI 48880-1926

Phone

(989) 681-6668

NPI assigned

May 3, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1525305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529107200000",
    "number": "1922597038",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "363 EDEN ST",
            "city": "KINGSLEY",
            "state": "MI",
            "postal_code": "496499289",
            "telephone_number": "231-620-5408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 HUBBARD ST",
            "city": "SAINT LOUIS",
            "state": "MI",
            "postal_code": "488801926",
            "telephone_number": "989-681-6668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEARSON",
        "first_name": "EDWARD",
        "middle_name": "LEE",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-05-03",
        "last_updated": "2018-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QA0505X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Adult Medicine",
            "state": "MI",
            "license": "4704206310",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NURSE PRACTITIONER SPECIALTY CERTIFICATION",
            "identifier": "4704206310",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stephen K Near, O.D.
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• Michael Palmer, M.S., BCBA
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• Kimberly Rose Prieskorn, PTA
• Amie Marie Ramirez, LPC
• Victoria Reagan
• Riverside Healthcare Center LLC

• All providers in Saint Louis, MI
• Adult Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 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; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.