NPIMap

Individual provider Active NPI

Edman Fuentes, PAC

  • Surgical Physician Assistant
  • Sonora, CA
National Provider Identifier
1013988955
Registry record updated Jan 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
PA51630 Issued in CA
Practice address
900 Greenley Rd
Suite 914
Sonora, CA 95370-5287
Phone
(925) 469-6274
Fax
(925) 924-1769
NPI assigned
Jan 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician Assistant 363AS0400X PA.008727 CO
Surgical Physician Assistant 363AS0400X PA51630 CA Primary

Addresses

Primary practice location

900 Greenley Rd
Suite 914
Sonora, CA 95370-5287

Mailing address

5725 W Las Positas Blvd
Suite 200
Pleasanton, CA 94588-4054
Phone (925) 469-6274

Other identifiers 3

IdentifierTypeStateIssuer
PA9102297OtherFLMEDICAL LICENSE
PA51630OtherCAMEDICAL LICENSE
291613400MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20250128004368 CO Practitioner - Physician Assistant 5092847699 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Portercare Adventist Health SystemGroup PAC ID 0941110886, 770 clinicians
Select Physical Therapy Holdings IncGroup PAC ID 9537076401, shared by 76 NPIs, 1,992 clinicians

Practice addresses (Care Compare)

145 Inverness Dr E
Englewood, CO 80112-5171
Phone (303) 697-7463

145 Inverness Dr E
220 Ahmg Peak Orthopedics and Spine at Inve
Englewood, CO 80112-5172
Phone (303) 699-7325

2525 S Downing St
Denver, CO 80210-5817

2535 D S Downing St
Suite 460
Denver, CO 80210-5817
Phone (303) 744-1065

2535 S Downing St
Denver, CO 80210-5850
Phone (303) 778-5797

730 14TH St SW
Loveland, CO 80537-6349
Phone (970) 663-0815

Hospital & facility affiliations

  • AdventHealth Porter Hospital, Denver, CO, CCN 060064
  • AdventHealth Littleton Hospital, Littleton, CO, CCN 060113
  • AdventHealth Parker Hospital, Parker, CO, CCN 060114

Merit-based Incentive Payment System (MIPS)

Final score
95.77 of 100Reported as apm
Quality
81.54
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
84.78 of 100Reported as group
Quality
81.74
Promoting interoperability
97
Improvement activities
40
Cost
67.27

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
51630CAMDPharmacist
PA51630CAMDSurgical Physician Assistant
PA.008727COMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Sonora Community Hospital CurrentSince Aug 1, 2020 Accepting new patients
Portercare Adventist Health System CurrentSince Jan 1, 2025 Accepting new patients
Portercare Adventist Health System CurrentSince Jan 1, 2025 Accepting new patients
Portercare Adventist Health System Past Accepting new patients

Locations

1000 Greenley Rd
Sonora, CA 95370
Phone (209) 263-0803

680 Guzzi Ln
Ste 106
Sonora, CA 95370
Phone (209) 532-2792

680 Guzzi Ln
Ste 201
Sonora, CA 95370
Phone (209) 536-1785

900 Greenley Rd
Ste 914
Sonora, CA 95370
Phone (209) 532-6128

145 Inverness Dr E
Ste 100
Englewood, CO 80112
Phone (303) 697-7463

Organizations & group practices 5

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 10

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": "1138579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737417600000",
    "number": "1013988955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5725 W LAS POSITAS BLVD",
            "address_2": "SUITE 200",
            "city": "PLEASANTON",
            "state": "CA",
            "postal_code": "945884054",
            "telephone_number": "925-469-6274",
            "fax_number": "925-924-1769"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 GREENLEY RD",
            "address_2": "SUITE 914",
            "city": "SONORA",
            "state": "CA",
            "postal_code": "953705287",
            "telephone_number": "925-469-6274",
            "fax_number": "925-924-1769"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUENTES",
        "first_name": "EDMAN",
        "name_prefix": "Mr.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-30",
        "last_updated": "2025-01-21",
        "certification_date": "2025-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CO",
            "license": "PA.008727",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CA",
            "license": "PA51630",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "PA9102297",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL LICENSE",
            "identifier": "PA51630",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "291613400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sonora, CA

Sources for this page

Verify at the official NPI Registry.