Individual provider Active NPI

Varner Edward Dudley III, M.D.

  • Anesthesiology Physician
  • Glendale, CA
National Provider Identifier
1114958592
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
G55075 Issued in CA
Practice address
1509 Wilson Ter
Glendale, CA 91206-4007
Phone
(818) 409-8000
Fax
(818) 546-5632
NPI assigned
Jul 5, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X G55075 CA Primary

Addresses

Primary practice location

1509 Wilson Ter
Glendale, CA 91206-4007

Mailing address

225 S Lake Ave
535
Pasadena, CA 91101-3005
Phone (626) 795-6596

Other identifiers 1

IdentifierTypeStateIssuer
00G550750MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080128000431 CA Practitioner - Anesthesiology 7214019454 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University of South Alabama College of Medicine, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Glendale Adventist Medical CenterGroup PAC ID 4284692096, 99 clinicians

Practice addresses (Care Compare)

1500 E Chevy Chase Dr
Suite 201
Glendale, CA 91206-4199
Phone (818) 863-4099

1509 Wilson Ter
Glendale, CA 91206-4007
Phone (818) 409-8000

Hospital & facility affiliations

  • Glendale Adventist Medical Center Hospital, Glendale, CA, CCN 050239

Merit-based Incentive Payment System (MIPS)

Final score
85.77 of 100Reported as group
Quality
78.77
Promoting interoperability
92
Improvement activities
40
Cost
48

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
G55075CAMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Consultants for Anesthesia & Management of Pain Anesthesiology CurrentSince Aug 9, 2018 Accepting new patients
Glendale Adventist Medical Center CurrentSince Mar 17, 2024 Accepting new patients
Glendale Adventist Medical Center CurrentSince Mar 17, 2024 Accepting new patients
White Memorial Medical Center CurrentSince Jan 24, 2025 Accepting new patients

Locations

1500 E Chevy Chase Dr
Ste 201
Glendale, CA 91206
Phone (818) 863-4099

1509 Wilson Ter
Glendale, CA 91206
Phone (818) 409-8071

1720 E Cesar E Chavez Ave
Los Angeles, CA 90033
Phone (323) 260-5781

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 1

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": "1152057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1114958592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 S LAKE AVE",
            "address_2": "535",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911013005",
            "telephone_number": "626-795-6596",
            "fax_number": "626-795-8247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1509 WILSON TER",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912064007",
            "telephone_number": "818-409-8000",
            "fax_number": "818-546-5632"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUDLEY",
        "first_name": "VARNER",
        "middle_name": "EDWARD",
        "name_suffix": "III",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "G55075",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G550750",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, CA

Sources for this page

Verify at the official NPI Registry.