Individual provider Active NPI

Edie E Zusman, MD

  • Neurological Surgery Physician
  • Fairfield, CA
National Provider Identifier
1629178637
Registry record updated Jan 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurological Surgery PhysicianTaxonomy code 207T00000X
License
G64158 Issued in CA
Practice address
1860 Pennsylvania Ave
Suite 320
Fairfield, CA 94533-3590
Phone
(707) 646-4370
Fax
(707) 646-4904
NPI assigned
Sep 22, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurological Surgery Physician 207T00000X G64158 CA Primary

Addresses

Primary practice location

1860 Pennsylvania Ave
Suite 320
Fairfield, CA 94533-3590

Mailing address

1860 Pennsylvania Ave
Suite 320
Fairfield, CA 94533-3590
Phone (707) 646-4370

Other identifiers 1

IdentifierTypeStateIssuer
00G641580MedicaidCA

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
I20090116000449 CA Practitioner - Neurosurgery 1850454810 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
64158CAMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Northbay Healthcare Group CurrentSince Feb 1, 2016 Accepting new patients
Northbay Healthcare Group Current Accepting new patients
Northbay Physicians Surgery Center LLC Past Accepting new patients

Locations

1860 Pennsylvania Ave
Ste 320
Fairfield, CA 94533
Phone (707) 260-5719

1200 B Gale Wilson Blvd
Fairfield, CA 94533
Phone (707) 429-3600

1000 Nut Tree Rd
Vacaville, CA 95687
Phone (707) 446-4000

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/UMZ-Uxn6V9x08sH5gCnG-5yPg9ZX7et6/

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452816000000",
    "number": "1629178637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1860 PENNSYLVANIA AVE",
            "address_2": "SUITE 320",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945333590",
            "telephone_number": "707-646-4370",
            "fax_number": "707-646-4904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1860 PENNSYLVANIA AVE",
            "address_2": "SUITE 320",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945333590",
            "telephone_number": "707-646-4370",
            "fax_number": "707-646-4904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ZUSMAN",
        "first_name": "EDIE",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-22",
        "last_updated": "2016-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "",
            "desc": "Neurological Surgery",
            "state": "CA",
            "license": "G64158",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G641580",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfield, CA

Sources for this page

Verify at the official NPI Registry.