Active NPI
Patrick Edgecomb
- Physical Therapist
- El Segundo, CA
National Provider Identifier
1346547320
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 19420
- Practice address
- 483 N Aviation Blvd
BLDG 210
El Segundo, CA 90245-2808 - Phone
- (310) 653-6878
- NPI assigned
- Feb 28, 2011
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 19420 | MA | Primary |
Addresses
Primary practice location
483 N Aviation Blvd
BLDG 210
El Segundo, CA 90245-2808
Mailing address
483 N Aviation Blvd
BLDG 210
El Segundo, CA 90245-2808
Phone (310) 653-6878
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Montowese Chiropractic Center LLC | 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 and National Provider Directory roles.
-
- Chiropractor
- North Haven, CT
- NPI 1982604567
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1298851200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1443657600000",
"number": "1346547320",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "483 N AVIATION BLVD",
"address_2": "BLDG 210",
"city": "EL SEGUNDO",
"state": "CA",
"postal_code": "902452808",
"telephone_number": "310-653-6878"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "483 N AVIATION BLVD",
"address_2": "BLDG 210",
"city": "EL SEGUNDO",
"state": "CA",
"postal_code": "902452808",
"telephone_number": "310-653-6878"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EDGECOMB",
"first_name": "PATRICK",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-02-28",
"last_updated": "2015-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MA",
"license": "19420",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in El Segundo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.