Active NPI
Edsmond Jerry Collins, PA PHD
- Physician Assistant
- SSF, CA
National Provider Identifier
1295891547
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA10067
- Practice address
- 3 South Linden Ave
SSF, CA 94080 - Phone
- (650) 589-2647
- Fax
- (650) 583-5549
- NPI assigned
- Dec 29, 2006
- Last updated
- Jul 8, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA10067 | CA | Primary |
Addresses
Primary practice location
3 South Linden Ave
SSF, CA 94080
Mailing address
3900 Doral Dr
Fairfield, CA 94533
Phone (707) 425-2824
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA10067 | CA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Carbon Health Primary Care of California PC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Multi-Specialty Clinic/Center
- Berkeley, CA
- NPI 1972057990
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167350400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1295891547",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3900 DORAL DR",
"city": "FAIRFIELD",
"state": "CA",
"postal_code": "94533",
"telephone_number": "707-425-2824",
"fax_number": "707-425-8970"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3 SOUTH LINDEN AVE",
"city": "SSF",
"state": "CA",
"postal_code": "94080",
"telephone_number": "650-589-2647",
"fax_number": "650-583-5549"
}
],
"practiceLocations": [],
"basic": {
"last_name": "COLLINS",
"first_name": "EDSMOND",
"middle_name": "JERRY",
"credential": "PA PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA10067",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in SSF, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.