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DR. ETHAN ALEXANDER EDMONDSON MD, MPH
NPI 1447719687
Student in an Organized Health Care Education/Training Program in Houston, TX

Active since March 18, 2019PECOS Enrolled
1 BAYLOR PLZ # BCM320, HOUSTON, TX 77030(832) 824-1170(832) 825-9302 Get Directions Write a Review

NPPES record last updated: March 18, 2019. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Dr. Ethan Alexander Edmondson Md, Mph NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. ETHAN ALEXANDER EDMONDSON MD, MPH (NPI 1447719687) is an individual student in an organized health care education/training program in Houston, Texas and active in the NPI registry since March 2019. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1447719687
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameDR. ETHAN ALEXANDER EDMONDSONCredential: MD, MPH
Location Address1 BAYLOR PLZ # BCM320Houston, TX 77030-3411
Mailing Address1 Baylor Plz # Bcm320Houston, TX 77030-3411 · (832) 824-1170 · Fax (832) 825-9302
Phone(832) 824-1170
Fax(832) 825-9302
Sole ProprietorNo
Enumeration DateMarch 18, 2019
✔ NPI 1447719687 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
1 BAYLOR PLZ # BCM320, Houston, TX 77030
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Ethan Alexander Edmondson Md, Mph is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Ethan Edmondson reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Permanente Medical Group Inc
1,589 mi
Internal Medicine
7373 WEST LANE
Stockton, CA 95210
  • Reassigned Medicare billing, California enrollment
  • 20,078 clinicians in this Medicare group
NPI 1548343510 (209) 476-2000

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KHANH LINH NGUYEN MD
Student in an Organized Health Care Education/Training Program
1 BAYLOR PLZ # BCM320
HOUSTON, TX 77030
Harris County (832) 824-1170
SRAVYA REDDY GURIVIREDDYGARI MD, MPH
Student in an Organized Health Care Education/Training Program
1 BAYLOR PLZ # BCM320
HOUSTON, TX 77030
Harris County (832) 824-1170
COURTNEY THUY HANG HUYNH
Student in an Organized Health Care Education/Training Program
1 BAYLOR PLZ # BCM320
HOUSTON, TX 77030
Harris County (832) 824-1170
ASHWIN SRIVATSAV
Student in an Organized Health Care Education/Training Program
1 BAYLOR PLZ # BCM320
HOUSTON, TX 77030
Harris County (832) 824-1170
CHARLES BURKE
Student in an Organized Health Care Education/Training Program
1 BAYLOR PLZ # BCM320
HOUSTON, TX 77030
Harris County (832) 824-1170
LAWRENCE WILLIAM MORRIS HAMILTON
Student in an Organized Health Care Education/Training Program
1 BAYLOR PLZ # BCM320
HOUSTON, TX 77030
Harris County (832) 824-1170
DR. ALISHA SADHWANI MBBS, BSC
Student in an Organized Health Care Education/Training Program
1 BAYLOR PLZ # BCM320
HOUSTON, TX 77030
Harris County (832) 824-1170
ELLEN WITTE MUELLER MD
Pediatrics
1 BAYLOR PLZ # BCM320
HOUSTON, TX 77030
Harris County (832) 824-1170

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ethan Edmondson's NPI number?

The NPI number for Ethan Edmondson is 1447719687. It was assigned to this individual provider in the NPPES registry on March 18, 2019.

Where is Ethan Edmondson located?

Ethan Edmondson practices at 1 Baylor Plz # Bcm320, Houston, TX 77030. The listed phone number is (832) 824-1170.

What is Ethan Edmondson's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Ethan Edmondson enrolled in Medicare?

Yes. Ethan Edmondson is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Ethan Edmondson's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Ethan Edmondson reassigns Medicare benefits to Permanente Medical Group Inc (Stockton, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Ethan Edmondson's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Ethan Edmondson was last updated on March 18, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.