Philippe Edouard, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

C51257 Issued in CA

Practice address

1179 N McDowell Blvd
Petaluma, CA 94954-6559

Phone

(707) 559-7500

Fax

(707) 559-7620

NPI assigned

Aug 9, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Petaluma Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Petaluma, CA
  • NPI 1588656268
  Medicare reassignment NPD
• Petaluma Health Center Inc

  • Federally Qualified Health Center (FQHC)
  • Rohnert Park, CA
  • NPI 1669870739
  NPD
• Petaluma Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Petaluma, CA
  • NPI 1437918406
  NPD
• SRM Alliance Hospital Services

  • Skilled Nursing Facility
  • Petaluma, CA
  • NPI 1770703886
  NPD (past)
• St. Joseph Health Northern California, LLC

  • General Acute Care Hospital
  • Santa Rosa, CA
  • NPI 1134152549
  NPD (past)
• Brunswick Urgent Care, LLC

  • Family Nurse Practitioner
  • Brunswick, GA
  • NPI 1023571411
  NPD (past)
• Nephrology & Hypertension Medical Associates, PC

  • Nephrology Physician
  • Jesup, GA
  • NPI 1437229309
  NPD (past)

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

{
    "created_epoch": "1123545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568937600000",
    "number": "1124029491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1179 N MCDOWELL BLVD",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949546559",
            "telephone_number": "707-559-7500",
            "fax_number": "707-559-7620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1179 N MCDOWELL BLVD",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949546559",
            "telephone_number": "707-559-7500",
            "fax_number": "707-559-7620"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5900 State Farm Dr Ste 200",
            "address_purpose": "LOCATION",
            "city": "Rohnert Park",
            "state": "CA",
            "postal_code": "949282149",
            "country_code": "US",
            "telephone_number": "707-559-7600",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1165 Montgomery Dr",
            "address_purpose": "LOCATION",
            "city": "Santa Rosa",
            "state": "CA",
            "postal_code": "954054801",
            "country_code": "US",
            "telephone_number": "707-546-3210",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "EDOUARD",
        "first_name": "PHILIPPE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-09",
        "last_updated": "2019-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "C51257",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00C512570",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeff Eaton, BCBA
• Scott W. Eberle, M.D.
• Juan Echeverria
• Kaila Alexandra Eddy-Cooke
• Johnna Marie Edmunds, FNP
• Marina Elizabeth Eggleston
• Iverson M. Eicken, PH.D.
• Eiler Sommerhaug MD Inc
• Nikki Einfeld, MS, AMFT, APCC
• Eitan Homa and Jennifer Krasnoff MD Inc

• Internal Medicine Physician in Petaluma, CA
• Providers in Petaluma, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.