Active NPI
Edsel Condez, P.A., M.M.S.
- Physician Assistant
- San Diego, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 53129
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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, OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 3
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
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 100
- 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
| License | State | Type | Specialty |
|---|---|---|---|
| 53129 | CA | MD | General Practice Dentistry |
| PA.PA.60615465 | WA | MD | Physician Assistant |
| PA60615465 | WA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Legacy Clinics LLC | Current | Accepting new patients | |
| Cep America - California | Current | Accepting new patients | |
| Family Health Centers of San Diego Inc | Current | Accepting new patients | |
| Family Health Centers of San Diego, Inc | Current | Accepting new patients | |
| Emergency Physicians Urgent Care Inc. | Current | 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.
-
- Urgent Care Clinic/Center
- Calabasas, CA
- NPI 1588901532
-
- Urgent Care Clinic/Center
- Bakersfield, CA
- NPI 1689963845
-
- Emergency Medicine Physician
- San Francisco, CA
- NPI 1023063542
-
- Federally Qualified Health Center (FQHC)
- San Diego, CA
- NPI 1447281936
-
- General Practice Physician
- Tigard, OR
- NPI 1023582178
-
- Emergency Medicine Physician
- Modesto, CA
- NPI 1639124167
-
- Federally Qualified Health Center (FQHC)
- San Diego, CA
- NPI 1235521782
-
- Federally Qualified Health Center (FQHC)
- Escondido, CA
- NPI 1356178180
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.