NPIMap

Individual provider Active NPI

Marwan Edris, M.D.

  • Internal Medicine Physician
  • Laguna Hills, CA
National Provider Identifier
1013045970
Registry record updated May 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A42896 Issued in CA
Practice address
25283 Cabot Road
Suite 106
Laguna Hills, CA 92653
Phone
(949) 364-9080
Fax
(949) 364-3856
NPI assigned
Mar 1, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 1, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X A42896 CA
Internal Medicine Physician 207R00000X A42896 CA Primary

Addresses

Primary practice location

25283 Cabot Road
Suite 106
Laguna Hills, CA 92653

Mailing address

25283 Cabot Road
Suite 106
Laguna Hills, CA 92653
Phone (949) 364-9080

Other identifiers 2

IdentifierTypeStateIssuer
710870022OtherCATAX ID #
A42896OtherCALICENSE #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031111000877 CA Practitioner - Internal Medicine 2163335266 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Marwan Edris MD a Professional CorporationGroup PAC ID 1355254459, 2 clinicians

Practice addresses (Care Compare)

25283 Cabot Rd
Suite 106
Laguna Hills, CA 92653-5509
Phone (949) 364-9080

Hospital & facility affiliations

  • Providence Mission Hospital Hospital, Mission Viejo, CA, CCN 050567
  • Memorialcare Saddleback Medical Center Hospital, Laguna Hills, CA, CCN 050603

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A42896CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Marwan Edris MD a Professional Corporation Internal Medicine CurrentSince Mar 1, 2002 Accepting new patients
Mission Hospital Regional Medical Center Past Accepting new patients
Saddleback Memorial Medical Center Past Accepting new patients
American Health Services of San Diego, LP PastSince Apr 8, 2004 Accepting new patients

Locations

25283 Cabot Rd
Ste 106
Laguna Hills, CA 92653
Phone (949) 364-9080

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/
  • Direct secure messaging: marwan.edris.p45@direct.monarchhealthcare.nextgenshare.com

Organizations & group practices 4

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

Hospital & facility affiliations 3

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": "1172707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714521600000",
    "number": "1013045970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25283 CABOT ROAD",
            "address_2": "SUITE 106",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "92653",
            "telephone_number": "949-364-9080",
            "fax_number": "949-364-3856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25283 CABOT ROAD",
            "address_2": "SUITE 106",
            "city": "LAGUNA HILLS",
            "state": "CA",
            "postal_code": "92653",
            "telephone_number": "949-364-9080",
            "fax_number": "949-364-3856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDRIS",
        "first_name": "MARWAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-01",
        "last_updated": "2024-05-01",
        "certification_date": "2024-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "A42896",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A42896",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID #",
            "identifier": "710870022",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE #",
            "identifier": "A42896",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Laguna Hills, CA

Sources for this page

Verify at the official NPI Registry.