Edwin Nathaniel Kendrick III, MD

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

C56176 Issued in CA

Practice address

3200 Inland Empire Blvd Ste 275
Ontario, CA 91764-5582

Phone

(626) 623-6040

Fax

(909) 366-5940

NPI assigned

Mar 9, 2011

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

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

Specialty

Vascular Surgery

Education

Morehouse School of Medicine, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Hospital & facility affiliations

• Emanate Health Foothill Presbyterian Hospital Hospital, Glendora, CA, CCN 050597

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/CDFICA/Endpoint/CDFICA

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.

• California Vein Vascular and Diagnostics, Inc.

  • Medical Specialty Clinic/Center
  • Ontario, CA
  • NPI 1710388103
  Medicare reassignment Authorized official
• Emanate Health Foothill Presbyterian Hospital

  • General Acute Care Hospital
  • Glendora, CA
  • NPI 1992733513
  NPD (past)
• Precise Hospice Inc.

  • Community Based Hospice Care Agency
  • Pasadena, CA
  • NPI 1689200842
  NPD (past)
• San Dimas Community Hospital, Inc.

  • Skilled Nursing Facility
  • San Dimas, CA
  • NPI 1568487619
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Emanate Health Foothill Presbyterian Hospital

  • General Acute Care Hospital
  • Glendora, CA
  • NPI 1992733513
  Care Compare affiliation

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

{
    "created_epoch": "1299628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672099200000",
    "number": "1265730618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 INLAND EMPIRE BLVD STE 275",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917645582",
            "telephone_number": "626-623-6040",
            "fax_number": "909-366-5940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 INLAND EMPIRE BLVD STE 275",
            "city": "ONTARIO",
            "state": "CA",
            "postal_code": "917645582",
            "telephone_number": "626-623-6040",
            "fax_number": "909-366-5940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENDRICK",
        "first_name": "EDWIN",
        "middle_name": "NATHANIEL",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-03-09",
        "last_updated": "2022-12-27",
        "certification_date": "2022-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "CA",
            "license": "C56176",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Adrianna Shanice Kelley
• Laura A. Kellick
• Anesha Kelly
• Marcus Kelly
• Christina Nicole Kemper
• Cory Kennedy
• Tyreisha Lanae Kennedy
• Yoojin Kennedy, PHARMD
• Betty Kenny
• Christina Kerby

• Vascular Surgery Physician in Ontario, CA
• Providers in Ontario, CA by specialty
• Vascular Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2022; 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.

Verify at the official NPI Registry.