Individual provider Active NPI

Edsel Condez, P.A., M.M.S.

  • Physician Assistant
  • San Diego, CA
National Provider Identifier
1073978680
Registry record updated Jun 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
53129 Issued in CA
Practice address
1809 National Ave
San Diego, CA 92113-2113
Phone
(619) 515-2300
NPI assigned
Dec 24, 2015
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA.PA.60615465 WA
Physician Assistant 363A00000X PA60615465 WA
Physician Assistant 363A00000X 53129 CA Primary

Addresses

Primary practice location

1809 National Ave
San Diego, CA 92113-2113

Mailing address

823 Gateway Center Way
San Diego, CA 92102-4541
Phone (619) 515-2300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, WA, OR3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20171114003563 CA Practitioner - Physician Assistant 9436439254 Reassigns benefits to 4 organizations
I20231122001848 WA Practitioner - Physician Assistant 9436439254 Reassigns benefits to 1 organization
I20240116001463 OR Practitioner - Physician Assistant 9436439254 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Exer Medical CorporationGroup PAC ID 9032359534, 336 clinicians

Practice addresses (Care Compare)

2300 Wilshire Blvd
Suite 104
Santa Monica, CA 90403-5863
Phone (424) 416-7900

26777 Agoura Rd
Suite B4
Calabasas, CA 91302-2967
Phone (818) 880-2225

475 Foothill Blvd
Suite K
La Canada, CA 91011-3555
Phone (818) 528-6377

600 S Lake Ave
Suite 105
Pasadena, CA 91106-3955
Phone (626) 844-8848

7077 Willoughby Ave
Suite 3
Los Angeles, CA 90038-2396
Phone (323) 826-5333

797 S Fair Oaks Ave
Suite 100
Pasadena, CA 91105-2617
Phone (626) 385-1455

8000 W Sunset Blvd
Suite C110
Los Angeles, CA 90046-2439
Phone (213) 412-0400

8135 N Painter Ave
Suite 104
Whittier, CA 90602-3164
Phone (562) 758-2345

Merit-based Incentive Payment System (MIPS)

Final score
94.62 of 100Reported as apm
Quality
77.21
Promoting interoperability
99.06
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
53129CAMDGeneral Practice Dentistry
PA.PA.60615465WAMDPhysician Assistant
PA60615465WAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Clinics LLC CurrentSince Nov 7, 2023 Accepting new patients
Cep America - California CurrentSince Dec 1, 2018 Accepting new patients
Family Health Centers of San Diego Inc CurrentSince Jun 28, 2024 Accepting new patients
Family Health Centers of San Diego, Inc CurrentSince Jun 28, 2024 Accepting new patients
Emergency Physicians Urgent Care Inc. CurrentSince Sep 10, 2019 Accepting new patients

Locations

2400 K St
Bakersfield, CA 93301
Phone (661) 885-9909

9710 Brimhall Rd
Bakersfield, CA 93312
Phone (661) 331-8640

4871 White Ln
Bakersfield, CA 93309
Phone (661) 832-1679

212 Coffee Rd
Ste 100
Bakersfield, CA 93309
Phone (661) 885-6060

6789 N Blackstone Ave
Fresno, CA 93710
Phone (559) 512-3377

1441 Florida Ave
Modesto, CA 95350
Phone (209) 214-7235

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

823 Gateway Center Way
San Diego, CA 92102
Phone (619) 515-2323

1809 National Ave
San Diego, CA 92113
Phone (619) 515-2500

41540 Winchester Rd
Temecula, CA 92590
Phone (951) 365-5585

1919 NW Lovejoy St
Portland, OR 97209
Phone (503) 415-5600

1130 NW 22nd Ave
Ste 220
Portland, OR 97210
Phone (503) 413-4134

305 SE Chkalov Dr
Ste 170
Vancouver, WA 98683
Phone (360) 799-3912

200 NE Mother Joseph Pl
Ste 410
Vancouver, WA 98664
Phone (503) 413-3580

Organizations & group practices 9

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1450915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719187200000",
    "number": "1073978680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "823 GATEWAY CENTER WAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921024541",
            "telephone_number": "619-515-2300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1809 NATIONAL AVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921132113",
            "telephone_number": "619-515-2300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONDEZ",
        "first_name": "EDSEL",
        "name_prefix": "Mr.",
        "credential": "P.A., M.M.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-12-24",
        "last_updated": "2024-06-24",
        "certification_date": "2024-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA.PA.60615465",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA60615465",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "53129",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.