Charmaine E Edwards, M.D.
Individual provider Active NPI Gastroenterology Physician · Red Bud, IL
NPI 1972586253 · NPPES record last updated Jun 28, 2021
Key facts
- NPI
- 1972586253
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Gastroenterology Physician 207RG0100X
- License
- 113266 (MO)
- Practice address
- 325 Spring Street
Red Bud, IL 62278 - Phone
- (618) 282-3831
- Fax
- (618) 282-5476
- NPI assigned
- Nov 21, 2005
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 10
Hospital & facility affiliations 6
Medicare Care Compare profile
- Specialty
- Gastroenterology
- Education
- Other, 1992
- Medicare assignment
- May accept Medicare assignment
- Group practices
- Red Bud Illinois Hospital Company LLC
Deaconess Illinois Red Bud Regional Hospital Inc
Ahs Il Medical Group LLC
Practice addresses (Care Compare)
325 Spring St
Red Bud, IL 62278-1105
4802 S State Route 159
Glen Carbon, IL 62034-1904
Phone (618) 288-4388
Hospital & facility affiliations
- Red Bud Regional Hospital
- Gateway Regional Medical Center
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Colonoscopy | 61 |
| Upper gastrointestinal (GI) endoscopy for acid reflux | 27 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161110001707 | IL | Practitioner - Gastroenterology | 1557451234 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036106745 | IL | MD | Gastroenterology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Deaconess Illinois Red Bud Regional Hospital Inc | Current |
Accepting new patients | |
| Deaconess Illinois Red Bud Regional Hospital Inc | Current |
Accepting new patients | |
| Ahs Il Medical Group LLC | Current |
Accepting new patients | |
| Physician Groups LC | Past | Accepting new patients | |
| DRS Pichet & Meechai | Past | Accepting new patients | |
| Multi-Care Medical, PC | Past | Accepting new patients | |
| Family Practice Associates, PC | Past | Accepting new patients | |
| Inpatient Consultants of Missouri Inc | Past | Accepting new patients | |
| West End Internal Medicine | Gastroenterology | Past | Accepting new patients |
| Capital Region Medical Center | Past | Accepting new patients |
Locations
1 Saint Anthonys Way
Alton, IL 62002
Phone (618) 233-6870
1000 Eleven S
Ste 1A
Columbia, IL 62236
Phone (618) 281-8400
4802 S State Route 159
Glen Carbon, IL 62034
Phone 61828843883331
2044 Madison Ave
Ste 27
Granite City, IL 62040
Phone (618) 451-0700
2044 Madison Ave
Ste G1
Granite City, IL 62040
Phone (618) 798-3350
2100 Madison Ave
Granite City, IL 62040
Phone (618) 798-3000
2100 Madison Ave
Ste 301
Granite City, IL 62040
8 Doctors Park Rd
Mount Vernon, IL 62864
Phone (618) 244-5500
325 Spring St
Redbud, IL 62278
Phone (618) 282-5165
509 Hamacher St
Ste 102
Waterloo, IL 62298
Phone (618) 798-8405
Interoperability endpoints
- charmaine.edwards.1@28328.direct.athenahealth.com
- charmaine.edwards.1@27782.direct.athenahealth.com
- ceedward@yourcarecommunity.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gastroenterology Physician | 207RG0100X | 036106745 | IL | |
| Gastroenterology Physician | 207RG0100X | 113266 | MO | Yes |
Addresses
Primary practice location
325 Spring Street
Red Bud, IL 62278
Mailing address
325 Spring Street
Red Bud, IL 62278
Phone (618) 282-3831
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 203825146 | Medicaid | MO |
Other providers in Red Bud, IL
- Deaconess Illinois Specialty Clinic, Inc.
- Stacy Diekmann
- Earl Gene Draves
- DRS Pichet & Meechai
- Ethan Louis Duclos
- Pamela Elizabeth Ehlers
- Jeremy Ryan Fletcher
- Kaitlin Floarke
- Focus Rehabilitation
- Shirley Marie Forcum
All providers in Red Bud, IL · Gastroenterology Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 28, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.