Individual provider Active NPI

Edwin Allen Maxwell, DO

  • Anesthesiology Physician
  • Davenport, IA
National Provider Identifier
1952387292
Registry record updated Apr 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
01682 Issued in IA
Practice address
1227 E Rusholme St
Davenport, IA 52803-2459
Phone
(563) 421-1000
Fax
(563) 421-7889
NPI assigned
Dec 19, 2005
Last updated
Apr 7, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 01682 IA Primary
Pain Medicine (Anesthesiology) Physician 207LP2900X 01682 IA

Addresses

Primary practice location

1227 E Rusholme St
Davenport, IA 52803-2459

Mailing address

PO Box 1245
Bettendorf, IA 52722-0021
Phone (563) 324-8160

Other identifiers 1

IdentifierTypeStateIssuer
2003467MedicaidIA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address edwin.maxwell@direct.genesishealth.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA
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
I20110606000386 IA Practitioner - Anesthesiology 4082693619 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
At Still University of Health Sciences, College of Osteo Med, Kirksville, 1977
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anesthesia and Analgesia PCGroup PAC ID 7810887627, 22 clinicians

Practice addresses (Care Compare)

1227 E Rusholme St
Davenport, IA 52803-2459
Phone (563) 324-8160

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
01682IAMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Anesthesia & Analgesia PC Anesthesiology CurrentSince Apr 1, 1994 Accepting new patients

Locations

2300 53rd Ave
Bettendorf, IA 52722
Phone (563) 332-4422

1227 E Rusholme St
Davenport, IA 52803
Phone (563) 324-8160

3319 Spring St
Davenport, IA 52807
Phone (319) 359-1641

3319 Spring St
Ste 202
Davenport, IA 52807
Phone (563) 355-6236

1401 W Central Park Ave
Davenport, IA 52804
Phone (563) 421-1900

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1134950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617753600000",
    "number": "1952387292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1245",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527220021",
            "telephone_number": "563-324-8160",
            "fax_number": "563-324-8486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1227 E RUSHOLME ST",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528032459",
            "telephone_number": "563-421-1000",
            "fax_number": "563-421-7889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAXWELL",
        "first_name": "EDWIN",
        "middle_name": "ALLEN",
        "name_prefix": "Mr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-19",
        "last_updated": "2021-04-07",
        "certification_date": "2021-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IA",
            "license": "01682",
            "primary": true
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "IA",
            "license": "01682",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2003467",
            "state": "IA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "edwin.maxwell@direct.genesishealth.com",
            "affiliation": "N",
            "endpointDescription": "Genesis Health System Direct Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "1227 E Rusholme St",
            "city": "Davenport",
            "state": "IA",
            "country_code": "US",
            "postal_code": "528032459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Davenport, IA

Sources for this page

Verify at the official NPI Registry.